Provider Demographics
NPI:1962717546
Name:FRISELLA, PATRICK DOMENICO (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:DOMENICO
Last Name:FRISELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:PATRIZIO
Other - Middle Name:DOMENICO
Other - Last Name:FRISELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:672 DOGWOOD AVE
Mailing Address - Street 2:#322
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3247
Mailing Address - Country:US
Mailing Address - Phone:516-510-4328
Mailing Address - Fax:
Practice Address - Street 1:672 DOGWOOD AVE
Practice Address - Street 2:#322
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3247
Practice Address - Country:US
Practice Address - Phone:516-510-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine