Healthcare Provider Details

I. General information

NPI: 1023429578
Provider Name (Legal Business Name): JODI FRIEDBERG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2014
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CEDARWOOD LN
COMMACK NY
11725-5617
US

IV. Provider business mailing address

16 CEDARWOOD LN
COMMACK NY
11725-5617
US

V. Phone/Fax

Practice location:
  • Phone: 631-513-9280
  • Fax: 613-543-0216
Mailing address:
  • Phone: 631-513-9280
  • Fax: 613-543-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023002264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: