Provider Demographics
NPI:1881828549
Name:WIEDERMAN, FRUMA LEAH (PA-C)
Entity Type:Individual
Prefix:
First Name:FRUMA
Middle Name:LEAH
Last Name:WIEDERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:F.
Other - Middle Name:LEAH
Other - Last Name:WIEDERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1665
Mailing Address - Country:US
Mailing Address - Phone:516-887-4335
Mailing Address - Fax:
Practice Address - Street 1:1800 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1665
Practice Address - Country:US
Practice Address - Phone:516-887-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-11
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093097363A00000X
NY013097363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant