Provider Demographics
NPI:1811296536
Name:ELIEZER A. FROMMER, MD, P.C.
Entity type:Organization
Organization Name:ELIEZER A. FROMMER, MD, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIEZER
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:FROMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-362-0527
Mailing Address - Street 1:31 PENNINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:NEW HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:10977-1418
Mailing Address - Country:US
Mailing Address - Phone:845-362-0527
Mailing Address - Fax:
Practice Address - Street 1:31 PENNINGTON WAY
Practice Address - Street 2:
Practice Address - City:NEW HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:10977-1418
Practice Address - Country:US
Practice Address - Phone:845-362-0527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254437208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03324825Medicaid