Healthcare Provider Details

I. General information

NPI: 1003086661
Provider Name (Legal Business Name): HARVEY A FREEDMAN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 SMITHTOWN BLVD
NESCONSET NY
11767-2043
US

IV. Provider business mailing address

276 SMITHTOWN BLVD
NESCONSET NY
11767-2043
US

V. Phone/Fax

Practice location:
  • Phone: 631-467-7600
  • Fax: 631-467-0945
Mailing address:
  • Phone: 631-467-7600
  • Fax: 631-467-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL A KOHAN
Title or Position: VICE PRESIDENT
Credential: DPM
Phone: 631-467-7600