Healthcare Provider Details

I. General information

NPI: 1912276452
Provider Name (Legal Business Name): NEW WAVE THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2011
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4073 CAMELLIA AVE
STUDIO CITY CA
91604-3007
US

IV. Provider business mailing address

4073 CAMELLIA AVE
STUDIO CITY CA
91604-3007
US

V. Phone/Fax

Practice location:
  • Phone: 818-428-8357
  • Fax: 818-753-9600
Mailing address:
  • Phone: 818-428-8357
  • Fax: 818-753-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEX FRIDMAN JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 818-428-8357