Provider Demographics
NPI:1881622447
Name:FDR MEDICAL SERVICES, P.C.
Entity type:Organization
Organization Name:FDR MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FILICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-366-2432
Mailing Address - Street 1:75 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2212
Mailing Address - Country:US
Mailing Address - Phone:716-366-2432
Mailing Address - Fax:716-366-4292
Practice Address - Street 1:75 E 5TH ST
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2212
Practice Address - Country:US
Practice Address - Phone:716-366-2432
Practice Address - Fax:716-366-4292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1711Medicare ID - Type Unspecified