Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 212969 | NY |
Y | 213ES0000X | Sports Medicine | 212969 | NY |
NPI | 1285758029 |
---|---|
Provider Name | Dr. Jason Moss Fritzhand |
First Address | White Plains, NY 10606-3418 |
Second Address | New York, NY 10019-2002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212969 | NYS LICENSE # (01) | NY |
G92929 | (02) | NY |