Basic Information
| Provider Information | |||||||||
| NPI: | 1295763902 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREYLE | ||||||||
| FirstName: | JAIME | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 247 ROUTE 100 | ||||||||
| Address2: | SUITE 1002 | ||||||||
| City: | SOMERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105893231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149628290 | ||||||||
| FaxNumber: | 9149628851 | ||||||||
| Practice Location | |||||||||
| Address1: | 909 49TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112192923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182837743 | ||||||||
| FaxNumber: | 7182836603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 002175 | NY | N | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | 241078 | NY | Y | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology |
ID Information
| ID | Type | State | Issuer | Description | 2579871 | 05 | NY | MEDICAID |