Provider Demographics
NPI:1417736695
Name:FREDANKEY FAMILY PRACTICE
Entity Type:Organization
Organization Name:FREDANKEY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KADEEJA
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDANKEY-PARZYCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-481-4960
Mailing Address - Street 1:14 KENNEDY PKWY
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1435
Mailing Address - Country:US
Mailing Address - Phone:607-591-4429
Mailing Address - Fax:
Practice Address - Street 1:14 KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1435
Practice Address - Country:US
Practice Address - Phone:607-591-4429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service