Mario Richard Fragala, M.D.
Individual provider Active NPI Psychiatry Physician · Malverne, NY
NPI 1629093786 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1629093786
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 104574-1 (NY)
- Practice address
- 163 Wicks LN
Malverne, NY 11565-2217 - Phone
- (516) 593-4758
- NPI assigned
- Jul 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 104574-1 | NY | MD | Psychiatry Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 104574-1 | NY | Yes |
Addresses
Primary practice location
163 Wicks LN
Malverne, NY 11565-2217
Mailing address
163 Wicks LN
Malverne, NY 11565-2217
Phone (516) 593-4758
Other providers in Malverne, NY
- F G L Drug Corp
- Vanessa Farrell
- Monica Carolina Fernandez
- David Flomenhaft
- Colleen Ann Ford
- Nailah Estelle Gabriel
- Peter T. Gambino
- Christina Marie Giardina
- Mary Ann Glick
- Daniella E Goldenstein
All providers in Malverne, NY · Psychiatry Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.