Individual
DR. JEREMY J FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 E 91ST ST, APT 5FW, NEW YORK, NY 10128-6026
(646) 643-4556
(212) 555-1234
Mailing address
320 E 91ST ST, APT 5FW, NEW YORK, NY 10128-6026
(646) 643-4556
(212) 555-1234
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
246451
NY
Other
Enumeration date
06/28/2007
Last updated
08/17/2016
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