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General NPI Number Information
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NPI Number | 1306048285
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Entity Type | Individual
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Provider Name | INDIRA MICHELLE FROMM RPA-C
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Gender | Female
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | STONY BROOK UNIVERSITY MEDICAL CTR HSC LEVEL 19 ROOM 060, DEPARTMENT OF SURGERY
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City | STONY BROOK
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State | NY
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Zip | 11794-0001
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Country | US
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Telephone | 631-444-8210
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Fax |
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Provider Business Mailing Address
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Address Line | 307 BOW DR
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City | HAUPPAUGE
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State | NY
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Zip | 11788-1721
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Country | US
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Telephone | 631-979-1190
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 010213
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License Number State | NY
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