Provider Demographics
NPI:1205887759
Name:FRACCHIA, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:FRACCHIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 54TH ST
Mailing Address - Street 2:2N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4707
Mailing Address - Country:US
Mailing Address - Phone:212-570-6800
Mailing Address - Fax:212-734-7425
Practice Address - Street 1:245 E 54TH ST
Practice Address - Street 2:2N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4707
Practice Address - Country:US
Practice Address - Phone:212-570-6800
Practice Address - Fax:212-734-7425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120845208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY354311Medicare ID - Type UnspecifiedMEDICARE ID
NY354315A772Medicare PIN
NYC09062Medicare UPIN