Provider Demographics
NPI:1346876216
Name:FRITCHE, JESSE BRYANT
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:BRYANT
Last Name:FRITCHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MARKET ST UNIT 12
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2744
Mailing Address - Country:US
Mailing Address - Phone:845-627-0023
Mailing Address - Fax:
Practice Address - Street 1:426 MARKET ST UNIT 12
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2744
Practice Address - Country:US
Practice Address - Phone:845-627-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14000044245237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist