Healthcare Provider Details

I. General information

NPI: 1356400014
Provider Name (Legal Business Name): TED L. FREEMAN,DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 JACK MARTIN BLVD SUITE B1
BRICK NJ
08724-7728
US

IV. Provider business mailing address

186 JACK MARTIN BLVD SUITE B1
BRICK NJ
08724-7728
US

V. Phone/Fax

Practice location:
  • Phone: 732-785-1600
  • Fax: 732-785-1642
Mailing address:
  • Phone: 732-785-1600
  • Fax: 732-785-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MB06110000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MB06110000
License Number StateNJ

VIII. Authorized Official

Name: TED L FREEMAN
Title or Position: OWNER
Credential: D.O.
Phone: 732-785-1600