Healthcare Provider Details

I. General information

NPI: 1144296849
Provider Name (Legal Business Name): FRED FRIEDMAN DDS/ ORTHODONTIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 ROUTE 35
CROSS RIVER NY
10518-1111
US

IV. Provider business mailing address

23 GIDEON REYNOLDS RD
CROSS RIVER NY
10518-1119
US

V. Phone/Fax

Practice location:
  • Phone: 914-763-5737
  • Fax:
Mailing address:
  • Phone: 914-977-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12713
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number38222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: