1881762029 NPI number — TED L FREEMAN DO

Table of content: TED L FREEMAN DO (NPI 1881762029)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881762029 NPI number — TED L FREEMAN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREEMAN
Provider First Name:
TED
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1881762029
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
186 JACK MARTIN BLVD
Provider Second Line Business Mailing Address:
SUITE B1
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-785-1600
Provider Business Mailing Address Fax Number:
732-785-1642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
186 JACK MARTIN BLVD
Provider Second Line Business Practice Location Address:
SUITE B1
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-785-1600
Provider Business Practice Location Address Fax Number:
732-785-1642
Provider Enumeration Date:
12/04/2006

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: 2081P2900X , with the licence number:  25MB06110000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208VP0014X , with the licence number: 25MB06110000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8067503 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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