Provider Demographics
NPI:1164438057
Name:FREILER, ELAINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:M
Last Name:FREILER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2779
Mailing Address - Country:US
Mailing Address - Phone:631-351-3744
Mailing Address - Fax:631-351-6175
Practice Address - Street 1:325 PARK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2779
Practice Address - Country:US
Practice Address - Phone:631-351-3744
Practice Address - Fax:631-351-6175
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153855-22085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06E491OtherBLUE CROSS/ BLUE SHIELD
NY2C4843OtherHEALTHNET
NY00914690Medicaid
NY4197246OtherGHI
NYCS111OtherOXFORD
NY06E491OtherBLUE CROSS/ BLUE SHIELD
NY06E491Medicare ID - Type Unspecified