Provider Demographics
NPI:1114416930
Name:GEFFRARD, FRITO
Entity Type:Individual
Prefix:
First Name:FRITO
Middle Name:
Last Name:GEFFRARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2552
Mailing Address - Country:US
Mailing Address - Phone:973-996-2775
Mailing Address - Fax:973-996-2784
Practice Address - Street 1:1550 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2552
Practice Address - Country:US
Practice Address - Phone:973-996-2775
Practice Address - Fax:973-996-2784
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver