Provider Demographics
NPI:1558469007
Name:FRICCHIONE, DONALD A (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:FRICCHIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:LAVALLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:08735-2832
Mailing Address - Country:US
Mailing Address - Phone:973-600-4691
Mailing Address - Fax:973-872-1009
Practice Address - Street 1:7 PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:LAVALLETTE
Practice Address - State:NJ
Practice Address - Zip Code:08735-2832
Practice Address - Country:US
Practice Address - Phone:973-600-4691
Practice Address - Fax:973-872-1009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02221400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1725106Medicaid
NJE63967Medicare UPIN
NJ553964Medicare ID - Type Unspecified