Healthcare Provider Details

I. General information

NPI: 1609191055
Provider Name (Legal Business Name): CONSTANTIN FRIEDMAN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK AVE
NEW YORK NY
10065-4805
US

IV. Provider business mailing address

1300 YORK AVE
NEW YORK NY
10065-4805
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2700
  • Fax:
Mailing address:
  • Phone: 212-746-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number269593
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: