Provider Demographics
NPI:1427120526
Name:FRYER DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:FRYER DERMATOLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-224-8200
Mailing Address - Street 1:21008 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3211
Mailing Address - Country:US
Mailing Address - Phone:718-224-8200
Mailing Address - Fax:718-819-0244
Practice Address - Street 1:21008 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3211
Practice Address - Country:US
Practice Address - Phone:718-224-8200
Practice Address - Fax:718-819-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185911 E 189419 J207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05061Medicare ID - Type UnspecifiedGHI GROUP NUMBER
NYW38571Medicare PIN