1457834327 NPI number — FRIEDMAN ORTHODONTICS

Table of content: (NPI 1457834327)

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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