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General NPI Number Information
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NPI Number | 1992394209
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Entity Type | Individual
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Provider Name | MARIAH DAWN FRAZIER-ESPEJO PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 132 CROSBY ST FL 2
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City | NEW YORK
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State | NY
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Zip | 10012-3363
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Country | US
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Telephone | 212-280-4740
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Fax |
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Provider Business Mailing Address
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Address Line | 18 MESEROLE ST APT 3B
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City | BROOKLYN
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State | NY
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Zip | 11206-1991
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Country | US
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Telephone | 360-912-3230
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 032118
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License Number State | NY
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