Healthcare Provider Details

I. General information

NPI: 1922100486
Provider Name (Legal Business Name): FREDERICK FRIEDMAN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RICKY FRIEDMAN M.D.

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 E 88TH ST FIRST FLOOR
NEW YORK NY
10128-1152
US

IV. Provider business mailing address

1 LAKE RD S
GREAT NECK NY
11020-1613
US

V. Phone/Fax

Practice location:
  • Phone: 212-534-0200
  • Fax: 212-534-2648
Mailing address:
  • Phone: 516-829-0136
  • Fax: 516-829-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number169304
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: