1578557344 NPI number — DR. MARTIN DANIEL FRIED MD

Table of content: DR. MARTIN DANIEL FRIED MD (NPI 1578557344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578557344 NPI number — DR. MARTIN DANIEL FRIED MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRIED
Provider First Name:
MARTIN
Provider Middle Name:
DANIEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1578557344
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3200 SUNSET AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
OCEAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-682-3425
Provider Business Mailing Address Fax Number:
732-455-3309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 SUNSET AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
OCEAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07712-4567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-682-3425
Provider Business Practice Location Address Fax Number:
732-455-3309
Provider Enumeration Date:
09/07/2005

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: 2080P0206X , with the licence number:  MA50309 , 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)





Copyright © 2007-2025 www.npivalidator.com