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NPI Code Detail

MEDICARE: FRADLIS GENERAL MEDICINE PC

MEDICARE: FRADLIS GENERAL MEDICINE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician210932NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538147780
Entity Type Code : Organization
Provider Name (Legal Business Name) : FRADLIS GENERAL MEDICINE PC
Provider Business Mailing Address
First Line : 606 MICHELLE PL
Second Line :
City : NORTH WOODMERE
State : NY
Zip : 11581-3041
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2829 OCEAN PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11235-7858
Country : US
Telephone Number : 718-891-6500
Fax Number : 718-891-5198
Authorized Official
Title or Position : PRESIDENT
Name : KLARA FRADLIS
Credential : M.D.
Telephone Number : 718-891-6500
Provider Enumeration Date : 01/06/2006
Last Update Date : 08/22/2020

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