Healthcare Provider Details

I. General information

NPI: 1497831846
Provider Name (Legal Business Name): STUART ADDIS FRIEDMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2006
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 MONTAGUE ST
BROOKLYN NY
11201-3521
US

IV. Provider business mailing address

132 MONTAGUE ST
BROOKLYN NY
11201-3521
US

V. Phone/Fax

Practice location:
  • Phone: 718-852-1149
  • Fax: 718-522-4379
Mailing address:
  • Phone: 718-852-1149
  • Fax: 718-522-4379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: