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General NPI Number Information
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NPI Number | 1932271020
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Entity Type | Individual
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Provider Name | JENNIFER FRYER MD
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/08/2010
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Provider Practice Location Address
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Address Line | 150 BROADHOLLOW RD SUITE 100
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City | MELVILLE
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State | NY
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Zip | 11747-4905
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Country | US
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Telephone | 631-673-5700
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Fax | 631-673-0506
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Provider Business Mailing Address
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Address Line | 21008 NORTHERN BLVD SUITE 2
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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 | 718-227-8200
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Fax | 718-819-0244
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 189419
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License Number State | NY
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