Provider Demographics
NPI:1992705974
Name:FRAGER, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:FRAGER
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 1:277 VAN CORTLANDT AVE E
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-3011
Mailing Address - Country:US
Mailing Address - Phone:718-798-8867
Mailing Address - Fax:718-881-7433
Practice Address - Street 1:277 VAN CORTLANDT AVE E
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3011
Practice Address - Country:US
Practice Address - Phone:718-798-8867
Practice Address - Fax:718-881-7433
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152389-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0036468OtherGHI
NY0H1578OtherPHS
NYGS035OtherOXFORD
NY0092498Medicaid
NYP2270371OtherAETNA
NY27861POtherHIP
NY683547OtherUNITED HEALTHCARE
NY683547OtherAETNA HMO
NY152389-A14OtherHEALTH FIRST
NY21B591OtherBLUES
NY113093221OtherCOMMERCIAL
NY1163743-016OtherCIGNA
NY113093221OtherCOMMERCIAL
NY21B591Medicare ID - Type Unspecified