Healthcare Provider Details

I. General information

NPI: 1225198138
Provider Name (Legal Business Name): SIMON H FRIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 EAST 14TH STR SUITE 120
BROOKLYN NY
11229
US

IV. Provider business mailing address

1636 EAST 14TH STR SUITE 120
BROOKLYN NY
11229
US

V. Phone/Fax

Practice location:
  • Phone: 718-339-2300
  • Fax: 718-998-8020
Mailing address:
  • Phone: 718-339-2300
  • Fax: 718-998-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number134959
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: