Provider Demographics
NPI:1285623520
Name:FREISINGER, GERARD MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:MARTIN
Last Name:FREISINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3973
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:15 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1522
Practice Address - Country:US
Practice Address - Phone:845-987-5147
Practice Address - Fax:845-986-1803
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY105585207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00537980Medicaid
NY565521Medicare ID - Type UnspecifiedMEDICARE ID
NY00537980Medicaid