1235177445 NPI number — DR. LESLIE FRIEDMAN OD

Table of content: DR. LESLIE FRIEDMAN OD (NPI 1235177445)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235177445 NPI number — DR. LESLIE FRIEDMAN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIEDMAN
Provider First Name:
LESLIE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1235177445
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 N CHURCH ST
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
MOORESTOWN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08057-2498
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-235-2620
Provider Business Mailing Address Fax Number:
856-235-0842

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N CHURCH ST
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
MOORESTOWN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08057-2498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-235-2620
Provider Business Practice Location Address Fax Number:
856-235-0842
Provider Enumeration Date:
06/02/2006

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: 152W00000X , with the licence number:  27OA005127 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0523887000 . This is a "KEYSTONE HPE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 88633 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0523887000 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "QUALCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272-008 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4995104 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 689196 . This is a "AMERIHEALTH PERSONAL CHOI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0523887000 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "HORIZON BCBSNJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "INTERGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "NJ CARPENTERS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "VSP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22839 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 223294272 . This is a "TRICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K6571 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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