Healthcare Provider Details

I. General information

NPI: 1013539220
Provider Name (Legal Business Name): NICOLE CHAE FRIEDMAN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 HUDSON ST
HOBOKEN NJ
07030-5638
US

IV. Provider business mailing address

660 WHITE PLAINS ROAD - ENTA FOURTH FLOOR
TARRYTOWN NY
10591-6802
US

V. Phone/Fax

Practice location:
  • Phone: 201-792-1109
  • Fax:
Mailing address:
  • Phone: 914-984-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number002986-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00109900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: