Provider Demographics
NPI:1780834739
Name:HAROLD FRITZ KEROLLE, MD, PC
Entity Type:Organization
Organization Name:HAROLD FRITZ KEROLLE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:FRITZ
Authorized Official - Last Name:KEROLLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-434-2992
Mailing Address - Street 1:1050 OCEAN AVE STE A1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-9205
Mailing Address - Country:US
Mailing Address - Phone:718-434-2992
Mailing Address - Fax:718-434-2997
Practice Address - Street 1:1050 OCEAN AVE STE A1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-9205
Practice Address - Country:US
Practice Address - Phone:718-434-2992
Practice Address - Fax:718-434-2997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK189432261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01432824Medicaid