Healthcare Provider Details

I. General information

NPI: 1518853746
Provider Name (Legal Business Name): AIDAN JACOB FRIED-FERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MADISON AVE
MADISON NJ
07940-1006
US

IV. Provider business mailing address

285 MADISON AVE
MADISON NJ
07940-1006
US

V. Phone/Fax

Practice location:
  • Phone: 973-443-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: