Provider Demographics
NPI:1437144490
Name:FAYNE L FREY MD PC
Entity Type:Organization
Organization Name:FAYNE L FREY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYNE
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-348-0501
Mailing Address - Street 1:2 CROSFIELD AVE
Mailing Address - Street 2:SUITE 319
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2226
Mailing Address - Country:US
Mailing Address - Phone:845-348-0501
Mailing Address - Fax:845-348-0531
Practice Address - Street 1:2 CROSFIELD AVE
Practice Address - Street 2:SUITE 319
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2226
Practice Address - Country:US
Practice Address - Phone:845-348-0501
Practice Address - Fax:845-348-0531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty