Healthcare Provider Details

I. General information

NPI: 1871706630
Provider Name (Legal Business Name): EUGENE FRIEDBERG MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E PALISADE AVE APT A9
ENGLEWOOD NJ
07631-2248
US

IV. Provider business mailing address

151 E PALISADE AVE APT A9
ENGLEWOOD NJ
07631-2248
US

V. Phone/Fax

Practice location:
  • Phone: 201-871-4778
  • Fax: 201-767-6926
Mailing address:
  • Phone: 201-871-4778
  • Fax: 201-767-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number23146
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number82800
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number82800
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23146
License Number StateNJ

VIII. Authorized Official

Name: DR. EUGENE ALEXANDER FRIEDBERG
Title or Position: OWNER
Credential: MD
Phone: 201-871-4778