Healthcare Provider Details

I. General information

NPI: 1659455194
Provider Name (Legal Business Name): JERALD S. FRIEDMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 CEDAR LN 2ND FL
TEANECK NJ
07666-3442
US

IV. Provider business mailing address

315 CEDAR LN 2ND FL
TEANECK NJ
07666-3442
US

V. Phone/Fax

Practice location:
  • Phone: 201-692-7737
  • Fax:
Mailing address:
  • Phone: 201-692-7737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01778900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: