Provider Demographics
NPI:1912967977
Name:IACOVONE, FRANK MICHAEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MICHAEL
Last Name:IACOVONE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 EAST 82 ST
Mailing Address - Street 2:APT. 16 A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:347-525-7535
Mailing Address - Fax:
Practice Address - Street 1:4422 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2545
Practice Address - Country:US
Practice Address - Phone:718-960-9177
Practice Address - Fax:718-960-9176
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06190100207R00000X, 207RC0000X, 207RI0011X
NY205968207RC0000X
VA0101249781207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2089494Medicaid
63B851Medicare ID - Type Unspecified
NYG43657Medicare UPIN