1518362557 NPI number — JARROD FRIEDMAN

Table of content: (NPI 1518362557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518362557 NPI number — JARROD FRIEDMAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JARROD FRIEDMAN
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:
JARROD FRIEDMAN
Provider Other Organization Name Type Code:
3
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:
1518362557
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5061 VIA DE AMALFI DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33496-2429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-795-0018
Provider Business Mailing Address Fax Number:
561-721-4142

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5061 VIA DE AMALFI DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33496-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-795-0018
Provider Business Practice Location Address Fax Number:
561-721-4142
Provider Enumeration Date:
11/04/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOLCOMBE
Authorized Official First Name:
SHEBORIA
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNT MANAGER
Authorized Official Telephone Number:
561-795-0018

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  ME107418 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ME107418 . This is a "ME107418" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".