Provider Demographics
NPI:1669458295
Name:DIFRANCO, FORTUNATO S (INTERNAL MEDICINE)
Entity Type:Individual
Prefix:DR
First Name:FORTUNATO
Middle Name:S
Last Name:DIFRANCO
Suffix:
Gender:M
Credentials:INTERNAL MEDICINE
Other - Prefix:DR
Other - First Name:FORTUNATO
Other - Middle Name:S
Other - Last Name:DIFRANCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7506 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-1034
Mailing Address - Country:US
Mailing Address - Phone:718-848-9100
Mailing Address - Fax:718-848-1114
Practice Address - Street 1:7506 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-1034
Practice Address - Country:US
Practice Address - Phone:718-848-9100
Practice Address - Fax:718-848-1114
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167562207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00974305Medicaid
E68858Medicare UPIN
NY00974305Medicaid