1457834327 NPI number — FRIEDMAN ORTHODONTICS

Table of content: MICHAEL ANDREW HUFF CRM (NPI 1982457123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457834327 NPI number — FRIEDMAN ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FRIEDMAN ORTHODONTICS
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:
1457834327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MEETING HOUSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERION STATION
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19066-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-617-9529
Provider Business Mailing Address Fax Number:
610-667-2438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 PROSPECT ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08701-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-667-1984
Provider Business Practice Location Address Fax Number:
610-667-2438
Provider Enumeration Date:
09/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEDMAN
Authorized Official First Name:
SHOLOM
Authorized Official Middle Name:
DOVID
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
610-667-1984

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  22DI02186300 , 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: 1376664979 . This is a "NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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