Provider Demographics
NPI:1194813204
Name:FROSOLONE, ENRICO (PT)
Entity type:Individual
Prefix:
First Name:ENRICO
Middle Name:
Last Name:FROSOLONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-2338
Mailing Address - Country:US
Mailing Address - Phone:716-284-4474
Mailing Address - Fax:716-284-4844
Practice Address - Street 1:2316 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2338
Practice Address - Country:US
Practice Address - Phone:716-284-4474
Practice Address - Fax:716-284-4844
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02726447Medicaid
NY9313114OtherINDEPENDENT HEALTH
NY000628316001OtherBC/BS
NYIA0908Medicare ID - Type Unspecified
NY9313114OtherINDEPENDENT HEALTH