Provider Demographics
NPI:1568642882
Name:FRIAS, PABLO (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:FRIAS
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 1:1005 SAINT NICHOLAS AVE 54
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:NY
Mailing Address - Zip Code:10032
Mailing Address - Country:US
Mailing Address - Phone:646-934-5774
Mailing Address - Fax:
Practice Address - Street 1:1005 SAINT NICHOLAS AVE APT 54
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5142
Practice Address - Country:US
Practice Address - Phone:212-923-7535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14-407246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant