Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 218366 | NY |
NPI | 1336220862 |
---|---|
Provider Name | Dr. Frederick S Arredondo |
First Address | Merrick, NY 11566-3122 |
Second Address | Merrick, NY 11566-3122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02087850 | (05) | NY |
A47849 | (02) | NY |