1417244633 NPI number — BARRY & FLORENCE FRIEDBERG JCC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417244633 NPI number — BARRY & FLORENCE FRIEDBERG JCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRY & FLORENCE FRIEDBERG JCC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417244633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/17/2011
NPI Reactivation Date:
10/12/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 NATIONAL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-3326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-431-2929
Provider Business Mailing Address Fax Number:
516-431-6278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 NEIL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-5815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-766-4341
Provider Business Practice Location Address Fax Number:
516-766-0513
Provider Enumeration Date:
07/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HALLERMAN
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR PROGRAM DIRECTOR
Authorized Official Telephone Number:
516-766-4441

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , with the licence number:  00041165BCC , 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)





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