Provider Demographics
NPI:1891848065
Name:FREDRIC NEWMAN MD LLC
Entity Type:Organization
Organization Name:FREDRIC NEWMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-656-9999
Mailing Address - Street 1:722 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4731
Mailing Address - Country:US
Mailing Address - Phone:203-656-9999
Mailing Address - Fax:718-672-4251
Practice Address - Street 1:722 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4731
Practice Address - Country:US
Practice Address - Phone:203-656-9999
Practice Address - Fax:718-672-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028727208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010028727CT01OtherANTHEM BLUE CROSS
NY0600716OtherGHI
CTCV2011OtherHEALTHNET
CTP2115448OtherOXFORD
NYB19409Medicare UPIN
NY8OA901Medicare ID - Type Unspecified