Provider Demographics
NPI:1538509237
Name:FREY, MICHELLE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FREY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 SARATOGA RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1694
Mailing Address - Country:US
Mailing Address - Phone:518-580-2185
Mailing Address - Fax:518-580-2211
Practice Address - Street 1:665 SARATOGA RD STE 400
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:NY
Practice Address - Zip Code:12831
Practice Address - Country:US
Practice Address - Phone:518-580-2185
Practice Address - Fax:518-580-2211
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2019-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant