Provider Demographics
NPI:1023072949
Name:FRACASSA, PHILIP CARMINE (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CARMINE
Last Name:FRACASSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:393 FRANKLIN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1227
Mailing Address - Country:US
Mailing Address - Phone:516-352-1380
Mailing Address - Fax:516-352-1381
Practice Address - Street 1:393 FRANKLIN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1227
Practice Address - Country:US
Practice Address - Phone:516-352-1380
Practice Address - Fax:516-352-1381
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY122364-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY660440OtherHEALTHCARE PARTNERS
NYAS639OtherOXFORD HEALTH PLANS
NY0094688OtherGHI
NY320111OtherBLUE CROSS/BUE SHIELD
NY25403POtherHIP
NY884939OtherAETNA
NY112526966OtherUNITED HEALTH CARE
NY112526966OtherUNITED HEALTH CARE
NY660440OtherHEALTHCARE PARTNERS