Provider Demographics
NPI:1427259373
Name:FRUCHTMAN, STEVEN M (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:FRUCHTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 PARK AVE
Mailing Address - Street 2:SUITE 1 FW
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1244
Mailing Address - Country:US
Mailing Address - Phone:212-427-7700
Mailing Address - Fax:212-996-8034
Practice Address - Street 1:1150 PARK AVE
Practice Address - Street 2:SUITE 1 FW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1244
Practice Address - Country:US
Practice Address - Phone:212-427-7700
Practice Address - Fax:212-996-8034
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135990174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00792558Medicaid
NY00792558Medicaid
NY02D771Medicare ID - Type Unspecified