Healthcare Provider Details

I. General information

NPI: 1528147196
Provider Name (Legal Business Name): D. CLARE FRIED M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S RM 8W-14, BUILDING 1, JMC
BRONX NY
10461-1138
US

IV. Provider business mailing address

1400 PELHAM PKWY S RM 8W-14, BUILDING 1, JMC
BRONX NY
10461-1138
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-4576
  • Fax: 718-918-6460
Mailing address:
  • Phone: 718-918-4576
  • Fax: 718-918-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number148822
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: