Provider Demographics
NPI:1558332502
Name:FRISICARO, GERALD (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:FRISICARO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 ROUTE 394
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-9708
Mailing Address - Country:US
Mailing Address - Phone:716-358-4237
Mailing Address - Fax:
Practice Address - Street 1:113 MAIN ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2100
Practice Address - Country:US
Practice Address - Phone:585-344-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0491Medicare PIN
NYS66567Medicare UPIN