Provider Demographics
NPI:1497856751
Name:FRYER, ERIC J (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:FRYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21008 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3211
Mailing Address - Country:US
Mailing Address - Phone:718-224-8200
Mailing Address - Fax:718-819-0244
Practice Address - Street 1:21008 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3211
Practice Address - Country:US
Practice Address - Phone:718-224-8200
Practice Address - Fax:718-819-0244
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185911207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2299670OtherGHI
NY2691300OtherAETNA
NYDS699OtherOXFORD
NYEF02K52220OtherEMPIRE BC/BS
NY010553448OtherTHE GUARDIAN
NY010185911NY02OtherANTHEM HEALTH OF NY
NY4C0917OtherHEALTHNET
NY30804POtherHIP OF NY
NY159125OtherELDERPLAN
NY010553448OtherTHE GUARDIAN
NYER0W385710Medicare ID - Type UnspecifiedGROUP EMPIRE MEDICARE #
NY05061Medicare ID - Type UnspecifiedGROUP GHI MEDICARE #
NY159125OtherELDERPLAN
NYEF02K61910Medicare ID - Type UnspecifiedINDIVIDUAL EMPIRE MEDICAR