=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538273354
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA J FRANK D O P C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2006
-----------------------------------------------------
Last Update Date | 12/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 66 S 21ST ST
-----------------------------------------------------
City | KENILWORTH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07033-1626
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-276-4447
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700N HABANA AVE 700
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33614-7122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-763-1151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MB50885
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------