Provider Demographics
NPI:1003881509
Name:FRATTA, KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:FRATTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W 238TH ST # A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2423
Mailing Address - Country:US
Mailing Address - Phone:718-601-3300
Mailing Address - Fax:718-601-0313
Practice Address - Street 1:226 W 238TH ST # A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2423
Practice Address - Country:US
Practice Address - Phone:718-601-3300
Practice Address - Fax:718-601-0313
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224858208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02366618Medicaid
NY02176772OtherMEDICAID GROUP