Healthcare Provider Details

I. General information

NPI: 1073796967
Provider Name (Legal Business Name): MARK BRIAN FRIEDMAN, DPM, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
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

302A WASHINGTON AVENUE EXT
ALBANY NY
12203-7303
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 TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MARK B FRIEDMAN
Title or Position: OWNER
Credential: DPM
Phone: 518-482-4321