1730180795 NPI number — DR. ABRAHAM RUBIN FREILICH M.D. PC

Table of content: (NPI 1649475799)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730180795 NPI number — DR. ABRAHAM RUBIN FREILICH M.D. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREILICH
Provider First Name:
ABRAHAM
Provider Middle Name:
RUBIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D. PC
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:
1730180795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/22/2006
NPI Reactivation Date:
04/11/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 QUENTIN RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11223-2251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-998-8291
Provider Business Mailing Address Fax Number:
718-375-5212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
813 QUENTIN RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-8291
Provider Business Practice Location Address Fax Number:
718-375-5212
Provider Enumeration Date:
08/02/2005

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: 174400000X , with the licence number:  133031 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00399651 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02901595 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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