Provider Demographics
NPI:1235239799
Name:NOTARNICOLA, FRED EUGENE SR (MD)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:EUGENE
Last Name:NOTARNICOLA
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:20 WETMORE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4439
Mailing Address - Country:US
Mailing Address - Phone:718-238-2625
Mailing Address - Fax:718-238-2704
Practice Address - Street 1:474 OVINGTON AVE STE LL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1554
Practice Address - Country:US
Practice Address - Phone:718-238-2625
Practice Address - Fax:718-238-2704
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY226352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY128AY1Medicare ID - Type Unspecified
NYH84262Medicare UPIN