MEDICARE: DR. PATRICK DOMENICO FRISELLA D.O.

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
1	207Q00000X	Family Medicine Physician	255862	NY

General Provider Information

NPI Number	:	1962717546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK DOMENICO FRISELLA D.O.

Provider Business Mailing Address
First Line	:	672 DOGWOOD AVE
Second Line	:	#322
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3247
Country	:	US
Telephone Number	:	516-510-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	672 DOGWOOD AVE
Second Line	:	#322
City	:	FRANKLIN SQUARE
State	:	NY
Zip	:	11010-3247
Country	:	US
Telephone Number	:	516-510-4328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2010
Last Update Date	:	05/06/2016

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