Healthcare Provider Details

I. General information

NPI: 1932030244
Provider Name (Legal Business Name): JACOB FRIEDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 TRUMAN AVE UNIT 111
SPRING VALLEY NY
10977-8180
US

IV. Provider business mailing address

62 TRUMAN AVE UNIT 111
SPRING VALLEY NY
10977-8180
US

V. Phone/Fax

Practice location:
  • Phone: 845-517-7882
  • Fax:
Mailing address:
  • Phone: 845-517-7882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number361657
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: