Healthcare Provider Details

I. General information

NPI: 1033170931
Provider Name (Legal Business Name): GARY SETH FRIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE BROOKDALE PLAZA OBH PHYSICIAN ENTERPRISE
BROOKLYN NY
11212-1121
US

IV. Provider business mailing address

1 BROOKDALE PLAZA PHYSICIAN ENTERPRISE
BROOKLYN NY
11212-3139
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5622
  • Fax: 718-240-5808
Mailing address:
  • Phone: 718-240-7143
  • Fax: 718-240-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number144674
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number15793
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number17079
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number104975
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18862
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number15793
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number17079
License Number StateOK
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number104975
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number18862
License Number StateWV
# 10
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number144674
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: