Healthcare Provider Details

I. General information

NPI: 1841249497
Provider Name (Legal Business Name): JERROLD A FRIEDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 CHESTNUT ST STE 204
PHILADELPHIA PA
19106-3051
US

IV. Provider business mailing address

PO BOX 1272
MOUNT LAUREL NJ
08054-7272
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-3782
  • Fax: 215-627-3695
Mailing address:
  • Phone: 856-383-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD067120L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA06914500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: