Provider Demographics
NPI:1558547133
Name:FRATERRIGO EYE PHYSICIANS &SURGEONS, PLLC
Entity Type:Organization
Organization Name:FRATERRIGO EYE PHYSICIANS &SURGEONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FRATERRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-382-1130
Mailing Address - Street 1:700 MCCLELLAN STREET
Mailing Address - Street 2:ST. CLARE'S MEDICAL ARTS BUILDING
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304
Mailing Address - Country:US
Mailing Address - Phone:518-382-1130
Mailing Address - Fax:518-382-1173
Practice Address - Street 1:700 MCCLELLAN STREET
Practice Address - Street 2:ST. CLARE'S MEDICAL ARTS BUILDING
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304
Practice Address - Country:US
Practice Address - Phone:518-382-1130
Practice Address - Fax:518-382-1173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1352Medicare PIN