Basic Information
| Provider Information | |||||||||
| NPI: | 1992893135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AVERSANO | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 264 MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY COTTAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109891424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452682188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 257 LAFAYETTE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453698800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 023651 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 274308 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.