Provider Demographics
NPI:1780772020
Name:FRISOLI, GAETANO (MD)
Entity type:Individual
Prefix:
First Name:GAETANO
Middle Name:
Last Name:FRISOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GARRY
Other - Middle Name:
Other - Last Name:FRISOLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:33 OVERLOOK ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:908-598-1020
Mailing Address - Fax:908-598-0989
Practice Address - Street 1:33 OVERLOOK ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-598-1020
Practice Address - Fax:908-598-0989
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA026152207V00000X
NJ25MA02615200207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UP062OtherOXFORD
NJ3367100Medicaid
0495278OtherAETNA
C55682Medicare UPIN
455143Medicare ID - Type Unspecified