Provider Demographics
NPI:1215582960
Name:FRAZIER, CARLNELL SAMUEL III (CPS)
Entity Type:Individual
Prefix:MR
First Name:CARLNELL
Middle Name:SAMUEL
Last Name:FRAZIER
Suffix:III
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 MADISON AVE APT 8G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1821
Mailing Address - Country:US
Mailing Address - Phone:929-345-5213
Mailing Address - Fax:
Practice Address - Street 1:25 FLATBUSH AVE STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2499
Practice Address - Country:US
Practice Address - Phone:718-852-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
NYNYCPS-P-810175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist