Healthcare Provider Details

I. General information

NPI: 1356384911
Provider Name (Legal Business Name): KAREN OLGA FRIED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E 77TH ST
NEW YORK NY
10075-1817
US

IV. Provider business mailing address

61 E 77TH ST
NEW YORK NY
10075-1817
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-3111
  • Fax:
Mailing address:
  • Phone: 212-772-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number173825
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number173825
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: