DR. PHILIP J. FRACCOLA (NPI# 1699767707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699767707 |
| Entity Type | Individual |
| Full Name | DR. PHILIP J. FRACCOLA |
| Credential | M.D. |
| Practice Address |
5100 W Taft Rd Suite 2a Liverpool NY 13088-3807 |
| Mailing Address |
4567 Crossroads Park Dr 2nd Floor Liverpool NY 13088-3589 |
| Practice Telephone | 3154522555 |
| Practice Fax Number | 3154522559 |
| Mailing Telephone | 3152952100 |
| Mailing Fax Number | 3152952125 |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
173758 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00555440 | 05 | |
| NY | 00555500 | 05 | |
| NY | 01334321 | 05 | |
| NY | 02224500 | 05 |
| Street Address |
5100 W TAFT RD SUITE 2A |
| City | LIVERPOOL |
| State | NY |
| Zip Code | 13088-3807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023015500 | Jody S Bleier | Internal Medicine | 5100 W Taft Rd, Suite 4j, Liverpool, NY 13088-3807 | 2005-06-30 |
| 1528620812 | Colleen Byrnes | Nurse Practitioner | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2019-07-08 |
| 1851866727 | Kathryn Quinn Manion | Clinic/Center | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2018-10-08 |
| 1225514623 | Shannon M Roach | Nurse Practitioner | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2018-07-18 |
| 1497263826 | Kimberly Cleary | Registered Nurse | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2018-01-19 |
| 1184077885 | Maia Czarnecki | Physician Assistant | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2016-07-18 |
| 1174974216 | Jenna Marie Laskey | Family Medicine | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2016-06-30 |
| 1669838108 | Phitsamai Thatvihane | Nurse Practitioner | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2016-01-14 |
| 1992160188 | Melissa Buttner | Physician Assistant | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2015-12-15 |
| 1538532940 | Chelsey Brooks | Physician Assistant | 5100 W Taft Rd, Suite 1c, Liverpool, NY 13088-3807 | 2015-11-06 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878966 | Anthony Edward Blumetti | Psychologist | 5100 W. Taft Road, Suite 3b, Liverpool, NY 13088 | 2019-12-12 |
| 1609350016 | Alice Nellenbach | Physical Therapy Assistant | 346 Electronics Pkwy, Liverpool, NY 13088 | 2018-09-20 |
| 1043741457 | Dawn Marie Thomas | Licensed Practical Nurse | 212 Old Liverpool Road, Building 7 Apartment 6, Liverpool, NY 13088 | 2017-03-27 |
| 1154775633 | Arielle L Leonard | Massage Therapist | 609 7th N. Street, Suite 2, Liverpool, NY 13088 | 2016-04-20 |
| 1942664362 | Accessibility Solutions, Inc. | Contractor | 115 Luther Avenue, Liverpool, NY 13088 | 2016-04-12 |
| 1497176333 | Sergey Golovko | Psychiatry & Neurology | 125 Sun Harbor Dr, Liverpool, NY 13088 | 2013-12-19 |
| 1205275286 | Brandon William Crandall | Nurse Practitioner | 5100 West Taft Rd., Suite 1c, Liverpool, NY 13088 | 2013-06-23 |
| 1184976805 | Audrey Irene Tyszka | Social Worker | 5100 W Taft Rd Ste 1f, Liverpool, NY 13088 | 2012-10-04 |
| 1790049096 | Kelley Beth Burt | Speech-Language Pathologist | 110 Elwood Davis Road, Liverpool, NY 13088 | 2012-07-02 |
| 1811288954 | Nedim Ruhotina | Urology | 100 Metropolitan Park Drive, Suite 100, Liverpool, NY 13088 | 2011-04-24 |
| Find all providers in zip 13088 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932489309 | Magnetic Resonance Imaging of Central New York, Pllc | Radiology | 5100 W Taft Rd, Liverpool, NY 13088-3807 | 2011-08-17 |
| 1356653729 | Shain L Wallis | Radiology | 5100 West Taft Rd, Ste 2a, Liverpool, NY 13088 | 2010-07-13 |
| 1497728091 | Christopher J Vaughn | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2006-02-13 |
| 1093709180 | St. Josephs Imaging Associates Pllc | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-09-06 |
| 1215920996 | Carmelita V Sanpedro | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-08-26 |
| 1053303040 | Gary D Leavitt | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-08-17 |
| 1265424261 | Steven R Lindemann | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-08-17 |
| 1164414066 | Sherwin C Pollock | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-08-17 |
| 1508858408 | Bernard N Raasch | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-08-17 |
| 1124010038 | John P Teixeira | Radiology | 5100 W Taft Rd, Suite 2a, Liverpool, NY 13088-3807 | 2005-08-17 |
| Find all providers in LIVERPOOL | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.