Provider Demographics
NPI:1740559012
Name:TRIFECTA HEALTH MEDICAL PC
Entity Type:Organization
Organization Name:TRIFECTA HEALTH MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRUITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-233-2830
Mailing Address - Street 1:115 BROADWAY
Mailing Address - Street 2:STE. 1300
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1604
Mailing Address - Country:US
Mailing Address - Phone:212-233-2830
Mailing Address - Fax:888-348-5193
Practice Address - Street 1:115 BROADWAY
Practice Address - Street 2:STE. 1300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1604
Practice Address - Country:US
Practice Address - Phone:212-233-2830
Practice Address - Fax:888-348-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY747423UPD261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health