Provider Demographics
NPI:1245272137
Name:HELLWITZ, FREDERIC JON (MD)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:JON
Last Name:HELLWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:6 WELLNESS WAY STE G06
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2135
Practice Address - Country:US
Practice Address - Phone:518-782-1600
Practice Address - Fax:518-786-1760
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2244562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02756196Medicaid
NYJ400002359Medicare UPIN
NY02756196Medicaid