Provider Demographics
NPI:1184715997
Name:FRUCHTMAN, NEIL
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:
Last Name:FRUCHTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3506
Mailing Address - Country:US
Mailing Address - Phone:631-427-6823
Mailing Address - Fax:631-427-2654
Practice Address - Street 1:2 COOPER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3506
Practice Address - Country:US
Practice Address - Phone:631-427-6823
Practice Address - Fax:631-427-2654
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02245132Medicaid
NY02245132Medicaid