Healthcare Provider Details

I. General information

NPI: 1205856465
Provider Name (Legal Business Name): ALAN HARRIS FRIEDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 TARGEE ST
STATEN ISLAND NY
10304-4323
US

IV. Provider business mailing address

227 MARTIN AVE
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax: 718-987-9610
Mailing address:
  • Phone: 718-698-8047
  • Fax: 718-987-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number189140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: