MEDICARE: DR. E. KENNETH FREIBERG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	104283	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0C138P	OTHER	NY	HIP
2	503988	OTHER	NY	AETNA
3	00153101	OTHER	NY	FIDELIS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871598169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E. KENNETH FREIBERG D.O.

Provider Business Mailing Address
First Line	:	102 NORMAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-2934
Country	:	US
Telephone Number	:	718-383-3068
Fax Number	:	516-239-8123

Provider Business Practice Location Address
First Line	:	102 NORMAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-2934
Country	:	US
Telephone Number	:	718-383-3068
Fax Number	:	516-239-8123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	11/04/2009

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