Healthcare Provider Details

I. General information

NPI: 1285697771
Provider Name (Legal Business Name): HENRY DAN FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VAMC/LAB113/C369 800 IRVING AVENUE
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

105 ALDEN ST
SYRACUSE NY
13210-3603
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4802
  • Fax: 315-425-4805
Mailing address:
  • Phone: 315-478-8425
  • Fax: 315-478-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number17155-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number177155-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number177155-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: