Provider Demographics
NPI:1659565075
Name:FROMMER, ELIEZER AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:AARON
Last Name:FROMMER
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 1:10 MILFORD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1412
Mailing Address - Country:US
Mailing Address - Phone:845-362-0527
Mailing Address - Fax:
Practice Address - Street 1:49 FOREST ROAD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-782-3242
Practice Address - Fax:845-782-2145
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08967000208000000X
NY254437208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0267341Medicaid
NY03292651Medicaid