Provider Demographics
NPI:1780670349
Name:FRISCIA, MARY ANNA (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANNA
Last Name:FRISCIA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2940 LOWER LINCOLN AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572
Mailing Address - Country:US
Mailing Address - Phone:516-678-3468
Mailing Address - Fax:516-678-1045
Practice Address - Street 1:2940 LOWER LINCOLN AVE
Practice Address - Street 2:STE 201
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572
Practice Address - Country:US
Practice Address - Phone:516-678-3468
Practice Address - Fax:516-678-1045
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN005430213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U70114Medicare UPIN
PVW481Medicare ID - Type Unspecified