Provider Demographics
NPI:1982608592
Name:FRAUWIRTH, NEAL H (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:H
Last Name:FRAUWIRTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 LARKFIELD RD FL 2
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-3131
Mailing Address - Country:US
Mailing Address - Phone:631-462-2225
Mailing Address - Fax:631-670-2643
Practice Address - Street 1:763 LARKFIELD RD FL 2
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-462-2225
Practice Address - Fax:631-670-2643
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209422-1208VP0014X, 208VP0000X
TN42862208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3000998Medicaid
TN4168373OtherBCBS
H52600Medicare UPIN
TN4168373OtherBCBS