Provider Demographics
NPI:1043240443
Name:BATKIN, FRED H (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:H
Last Name:BATKIN
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 1:701 E 28TH ST
Mailing Address - Street 2:116
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-424-8111
Mailing Address - Fax:562-492-6830
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:116
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-424-8111
Practice Address - Fax:562-492-6830
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56425208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG56425BMedicare PIN