Provider Demographics
NPI:1780558189
Name:FRAY, JESSICA DANIELLE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DANIELLE
Last Name:FRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STOKUM LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3505
Mailing Address - Country:US
Mailing Address - Phone:845-634-4974
Mailing Address - Fax:
Practice Address - Street 1:11 STOKUM LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3505
Practice Address - Country:US
Practice Address - Phone:845-634-4974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2025039691207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine