Individual
KEITH EVAN FRAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1914
(201) 488-0066
(201) 488-6769
Mailing address
PO BOX 18914, NEWARK, NJ 07191-8914
(201) 488-0066
(201) 488-6769
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MB07888800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076325
—
NJ
05
—
02672993
—
NY
01
—
P00265429
RAILROAD MEDICARE
NJ
Enumeration date
11/18/2005
Last updated
05/21/2008
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