Healthcare Provider Details

I. General information

NPI: 1134708225
Provider Name (Legal Business Name): JACOB FRIED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 W KLEIN RD
BUFFALO NY
14221-1302
US

IV. Provider business mailing address

28 W KLEIN RD
BUFFALO NY
14221-1302
US

V. Phone/Fax

Practice location:
  • Phone: 914-584-0298
  • Fax:
Mailing address:
  • Phone: 716-215-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD495464
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: