Healthcare Provider Details

I. General information

NPI: 1871598169
Provider Name (Legal Business Name): E. KENNETH FREIBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EDWARD KENNETH FREIBERG D.O.

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 NORMAN AVE
BROOKLYN NY
11222-2934
US

IV. Provider business mailing address

102 NORMAN AVE
BROOKLYN NY
11222-2934
US

V. Phone/Fax

Practice location:
  • Phone: 718-383-3068
  • Fax: 516-239-8123
Mailing address:
  • Phone: 718-383-3068
  • Fax: 516-239-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number104283
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: