Provider Demographics
NPI:1609890292
Name:FRIGERIO, JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:
Last Name:FRIGERIO
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 1:59 SEASONGOOD RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6032
Mailing Address - Country:US
Mailing Address - Phone:718-779-2000
Mailing Address - Fax:718-779-1583
Practice Address - Street 1:8708 JUSTICE AVE
Practice Address - Street 2:1H
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4575
Practice Address - Country:US
Practice Address - Phone:718-779-2000
Practice Address - Fax:718-779-1583
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY133857207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112766693OtherTAX ID
NY112766693OtherTAX ID
NY25805Medicare PIN