1255338661 NPI number — ALYSE FRIEDMAN PT

Table of content: ALYSE FRIEDMAN PT (NPI 1255338661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255338661 NPI number — ALYSE FRIEDMAN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
ALYSE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

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:
1255338661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1212 YORK RD
Provider Second Line Business Mailing Address:
SUITE C-101
Provider Business Mailing Address City Name:
LUTHERVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-6240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-321-0377
Provider Business Mailing Address Fax Number:
410-821-7517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1212 YORK RD
Provider Second Line Business Practice Location Address:
SUITE C-101
Provider Business Practice Location Address City Name:
LUTHERVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21093-6240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-321-0377
Provider Business Practice Location Address Fax Number:
410-821-7517
Provider Enumeration Date:
06/30/2005

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: 2251X0800X , with the licence number:  16873 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251S0007X , with the licence number: 16873 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 472317 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 074734300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00202713 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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