Provider Demographics
NPI:1225661309
Name:MUNTZ, FREDRYCCA CERUSSI SR (MED)
Entity Type:Individual
Prefix:MRS
First Name:FREDRYCCA
Middle Name:CERUSSI
Last Name:MUNTZ
Suffix:SR
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:FREDI
Other - Middle Name:
Other - Last Name:MUNTZ
Other - Suffix:SR
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:87 CROSS POND RD
Mailing Address - Street 2:
Mailing Address - City:POUND RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:10576
Mailing Address - Country:US
Mailing Address - Phone:914-318-6491
Mailing Address - Fax:914-977-3962
Practice Address - Street 1:87 CROSS POND RD
Practice Address - Street 2:
Practice Address - City:POUND RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10576
Practice Address - Country:US
Practice Address - Phone:914-318-6491
Practice Address - Fax:914-977-3962
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency