Healthcare Provider Details

I. General information

NPI: 1639221450
Provider Name (Legal Business Name): MARK BRIAN FRIEDMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302A WASHINGTON AVENUE EXT
ALBANY NY
12203-7303
US

IV. Provider business mailing address

PO BOX 125
SLINGERLANDS NY
12159-0125
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-4321
  • Fax: 518-482-4664
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 NumberN005533-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: