Healthcare Provider Details

I. General information

NPI: 1992740526
Provider Name (Legal Business Name): PHILIP FREEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

PO BOX 30548
NEW YORK NY
10087-0548
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1435
  • Fax:
Mailing address:
  • Phone: 517-787-6440
  • Fax: 517-787-4146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number096134
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: