Healthcare Provider Details

I. General information

NPI: 1346240686
Provider Name (Legal Business Name): EUGENE B FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 JERICHO TPKE
FLORAL PARK NY
11001-2146
US

IV. Provider business mailing address

68 S SERVICE RD SUITE 350
MELVILLE NY
11747-2354
US

V. Phone/Fax

Practice location:
  • Phone: 516-354-7575
  • Fax: 516-354-3977
Mailing address:
  • Phone: 516-945-3000
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number104138
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: