Healthcare Provider Details

I. General information

NPI: 1972067692
Provider Name (Legal Business Name): JAKE FRIEDLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2019
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 E EVANS RD STE C2
SCOTTSDALE AZ
85260-3639
US

IV. Provider business mailing address

19 MAYFAIR CT
LITTLE SILVER NJ
07739-1238
US

V. Phone/Fax

Practice location:
  • Phone: 480-470-9613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: