Provider Demographics
NPI:1285758029
Name:FRITZHAND, JASON MOSS (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MOSS
Last Name:FRITZHAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3418
Mailing Address - Country:US
Mailing Address - Phone:212-757-1157
Mailing Address - Fax:212-757-7197
Practice Address - Street 1:1776 BROADWAY FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2002
Practice Address - Country:US
Practice Address - Phone:212-757-1157
Practice Address - Fax:212-757-7197
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2129692081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY212969OtherNYS LICENSE #
NYG92929Medicare UPIN