=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851260855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHOENIX FRICK
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/30/2025
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 IRVING AVE
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-425-4400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8044 CAZENOVIA RD
-----------------------------------------------------
City | MANLIUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13104-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-877-8817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WM0705X
-----------------------------------------------------
Taxonomy Name | Medical-Surgical Registered Nurse
-----------------------------------------------------
License Number | N06635-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------