Provider Demographics
NPI:1992574974
Name:FRAWLEY, JON ALEXANDER
Entity type:Individual
Prefix:
First Name:JON
Middle Name:ALEXANDER
Last Name:FRAWLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S 3RD ST APT 4087
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2181
Mailing Address - Country:US
Mailing Address - Phone:973-960-9678
Mailing Address - Fax:
Practice Address - Street 1:777 S 3RD ST APT 4087
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2181
Practice Address - Country:US
Practice Address - Phone:973-960-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier