=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114246733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH FRAGER, M.D. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2010
-----------------------------------------------------
Last Update Date | 05/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 277 VAN CORTLANDT AVE E
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-798-8867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 277 VAN CORTLANDT AVE E
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10467-3011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-798-8867
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPH DANIEL FRAGER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-798-8867
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------