Individual
EDWARD J FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
111 E 210TH ST, MMC - DEPT. OF MEDICINE, BRONX, NY 10467-2401
(718) 920-6700
Mailing address
110 DEHAVEN DR, APT. 222, YONKERS, NY 10703-1278
(718) 920-6700
(718) 920-7447
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002473
NY
Other
Enumeration date
02/27/2007
Last updated
07/08/2007
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