Provider Demographics
NPI:1326629239
Name:FRALEY, MATTHEW (CNIM)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FRALEY
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BOWAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1603
Mailing Address - Country:US
Mailing Address - Phone:917-673-1555
Mailing Address - Fax:
Practice Address - Street 1:124 BOWAY RD
Practice Address - Street 2:
Practice Address - City:SOUTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10590-1603
Practice Address - Country:US
Practice Address - Phone:917-673-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic