Provider Demographics
NPI:1124107784
Name:FRAY, CECILE INGRID (MD)
Entity type:Individual
Prefix:DR
First Name:CECILE
Middle Name:INGRID
Last Name:FRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SAW MILL RIVER RD
Mailing Address - Street 2:SUITE 1025
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2614
Mailing Address - Country:US
Mailing Address - Phone:914-478-4883
Mailing Address - Fax:914-478-4885
Practice Address - Street 1:410 SAW MILL RIVER RD
Practice Address - Street 2:SUITE 1025
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2614
Practice Address - Country:US
Practice Address - Phone:914-478-4883
Practice Address - Fax:914-478-4885
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00973648Medicaid
NYA64395Medicare UPIN