1306840038 NPI number — DR. CARL BERTRAM FRIEDMAN M.D.

Table of content: DR. CARL BERTRAM FRIEDMAN M.D. (NPI 1306840038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306840038 NPI number — DR. CARL BERTRAM FRIEDMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
CARL
Provider Middle Name:
BERTRAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306840038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/20/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 MAPLE AVE
Provider Second Line Business Mailing Address:
STE 203
Provider Business Mailing Address City Name:
CEDARHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11516-2240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 MAPLE AVE
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
CEDARHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11516-2240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-374-1818
Provider Business Practice Location Address Fax Number:
516-374-1830
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  106697 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00187320 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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