Healthcare Provider Details

I. General information

NPI: 1134541493
Provider Name (Legal Business Name): MARK D. FRIEDMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 NEW OCEAN ST
SWAMPSCOTT MA
01907-1831
US

IV. Provider business mailing address

70 NEW OCEAN ST
SWAMPSCOTT MA
01907-1831
US

V. Phone/Fax

Practice location:
  • Phone: 781-581-7300
  • Fax:
Mailing address:
  • Phone: 781-581-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number1452
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberAH-11085
License Number StateMA

VIII. Authorized Official

Name: DR. MARK D FRIEDMAN
Title or Position: OWNER/CLINICIAN
Credential: D.C.
Phone: 781-581-7300