=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558469007
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD A FRICCHIONE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 PERSHING BLVD
-----------------------------------------------------
City | LAVALLETTE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08735-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-600-4691
-----------------------------------------------------
Fax | 973-872-1009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7 PERSHING BLVD
-----------------------------------------------------
City | LAVALLETTE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08735-2832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-600-4691
-----------------------------------------------------
Fax | 973-872-1009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 25MA02221400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------