Healthcare Provider Details

I. General information

NPI: 1922170356
Provider Name (Legal Business Name): DR.JEROME T. FRIEDMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800A 5TH AVE SUITE 403
NEW YORK NY
10021-7215
US

IV. Provider business mailing address

800A 5TH AVE SUITE 403
NEW YORK NY
10021-7215
US

V. Phone/Fax

Practice location:
  • Phone: 212-371-9085
  • Fax:
Mailing address:
  • Phone: 212-371-9085
  • Fax: 212-486-6955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number023857
License Number StateNY

VIII. Authorized Official

Name: JEROME T FRIEDMAN
Title or Position: D.D.S.
Credential:
Phone: 212-371-9085