Healthcare Provider Details

I. General information

NPI: 1225540248
Provider Name (Legal Business Name): MARK BRIAN FRIEDMAN, DPM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EXECUTIVE PARK DR
ALBANY NY
12203-3791
US

IV. Provider business mailing address

PO BOX 125
SLINGERLANDS NY
12159-0125
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-4321
  • Fax: 518-482-4321
Mailing address:
  • Phone: 518-482-4321
  • Fax: 518-482-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK BRIAN FRIEDMAN
Title or Position: OWNER
Credential: DPM
Phone: 518-482-4321