Provider Demographics
NPI:1548405392
Name:FRAGOSO, RALPH
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:FRAGOSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1108
Mailing Address - Country:US
Mailing Address - Phone:914-965-3700
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:50 DAYTON LN STE 205
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2860
Practice Address - Country:US
Practice Address - Phone:914-736-3371
Practice Address - Fax:914-736-3372
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940OtherAGENCY MEDICAID PROVIDER ID
NYWVE061OtherAGENCY MEDICARE ID#
NY1285628552OtherAGENCY NPI #