Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 289828-01 | NY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 289828-01 | NY |
NPI | 1215356712 |
---|---|
Provider Name | Ellen Fraint |
First Address | Bronx, NY 10467-2552 |
Second Address | Bronx, NY 10467-2552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2014 |
Last Update Date | 18/06/2021 |