Healthcare Provider Details

I. General information

NPI: 1952453722
Provider Name (Legal Business Name): FRIEDA NEUSCHOTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JERICHO TPKE SUITE 206
JERICHO NY
11753-1073
US

IV. Provider business mailing address

99 JERICHO TPKE SUITE 206
JERICHO NY
11753-1073
US

V. Phone/Fax

Practice location:
  • Phone: 516-338-2900
  • Fax: 516-338-2902
Mailing address:
  • Phone: 516-338-2900
  • Fax: 516-338-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number170954
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: