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General NPI Number Information
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NPI Number | 1427120526
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Entity Type | Organization
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Legal Business Name | FRYER DERMATOLOGY, PLLC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 21008 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3211
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Country | US
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Telephone | 718-224-8200
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Fax | 718-819-0244
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Provider Business Mailing Address
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Address Line | 21008 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3211
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Country | US
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Telephone | 718-224-8200
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Fax | 718-819-0244
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Authorized Official
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Title or Position | OWNER
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Name | ERIC J FRYER
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Credential | MD
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Telephone | 718-224-8200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 185911 E 189419 J
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License Number State | NY
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