Provider Demographics
NPI:1497781462
Name:OCCHINO, FREDERICK M (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:OCCHINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:FREDERICK
Other - Middle Name:M
Other - Last Name:OCCHINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:517 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-4231
Mailing Address - Country:US
Mailing Address - Phone:716-646-2590
Mailing Address - Fax:716-646-2593
Practice Address - Street 1:517 SUNSET DR
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-4231
Practice Address - Country:US
Practice Address - Phone:716-646-2590
Practice Address - Fax:716-646-2593
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11880207Q00000X, 207QA0401X
NY108941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00593724Medicaid
NY00593724Medicaid
NY033511Medicare ID - Type UnspecifiedMEDICARE