Healthcare Provider Details

I. General information

NPI: 1013911957
Provider Name (Legal Business Name): JEFFREY LAWRENCE FRIEDMAN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 CAREW ST
SPRINGFIELD MA
01104-2377
US

IV. Provider business mailing address

71 HARVEST LN
WEST HARTFORD CT
06117-2328
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-9000
  • Fax:
Mailing address:
  • Phone: 860-231-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number225175
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: