Provider Demographics
NPI:1548382468
Name:FRISHKOFF, SIMON (ND)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:FRISHKOFF
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6961
Mailing Address - Country:US
Mailing Address - Phone:802-274-0083
Mailing Address - Fax:802-985-9846
Practice Address - Street 1:145 PINE HAVEN SHORES RD
Practice Address - Street 2:SUITE 2165
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7703
Practice Address - Country:US
Practice Address - Phone:802-985-9856
Practice Address - Fax:802-985-9846
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099-0000084175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath