Healthcare Provider Details

I. General information

NPI: 1205074945
Provider Name (Legal Business Name): ABRAHAM FRIDMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COMMERCE DR
SHELTON CT
06484-6244
US

IV. Provider business mailing address

67 MAPLE AVE FL 2
DERBY CT
06418-1328
US

V. Phone/Fax

Practice location:
  • Phone: 203-926-1897
  • Fax: 203-225-7744
Mailing address:
  • Phone: 203-732-1330
  • Fax: 203-732-1332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number051159
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: