Basic Information
Provider Information
NPI: 1619978160
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLOYD
FirstName: FRANK
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 33 LEWIS RD
Address2: 2ND FL
City: BINGHAMTON
State: NY
PostalCode: 13905
CountryCode: US
TelephoneNumber: 6077298156
FaxNumber:  
Practice Location
Address1: 800 HOOPER ROAD
Address2:  
City: ENDWELL
State: NY
PostalCode: 13760
CountryCode: US
TelephoneNumber: 6077570444
FaxNumber: 6077488984
Other Information
ProviderEnumerationDate: 08/09/2005
LastUpdateDate: 04/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X172307NYY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
0105174305NY MEDICAID


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