Healthcare Provider Details

I. General information

NPI: 1902411184
Provider Name (Legal Business Name): TROY FRIEDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19609 S MCQUEEN RD
CHANDLER AZ
85286-1903
US

IV. Provider business mailing address

31 E VERNON AVE
PHOENIX AZ
85004-1338
US

V. Phone/Fax

Practice location:
  • Phone: 623-850-5400
  • Fax: 623-321-7850
Mailing address:
  • Phone: 844-546-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: