Provider Demographics
NPI:1609836592
Name:FRATTAROLA, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:FRATTAROLA
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 1:870 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3419
Mailing Address - Country:US
Mailing Address - Phone:201-907-0900
Mailing Address - Fax:201-907-0229
Practice Address - Street 1:870 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3419
Practice Address - Country:US
Practice Address - Phone:201-907-0900
Practice Address - Fax:201-907-0229
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03819000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0073913000OtherAMERIHEALTH ID #
NJ24464OtherAMERICAID AMERIGROUP
NJ4401167OtherAETNA PPO ID #
NJ560039OtherAETNA HMO ID #
NJ1160888OtherHORIZON NJ HEALTH
NJBP355OtherOXFORD ID #
NJ1042435OtherHORIZON NJ HEALTH ID #
NJ2K1111OtherHEALTHNET
NJ3287203Medicaid
NJ160041568OtherRAILROAD MEDICARE
NJ17258OtherUNIVERSITY HEALTH PLANS
NJ2K1111OtherHEALTHNET
NJ24464OtherAMERICAID AMERIGROUP