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General NPI Number Information
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NPI Number | 1073067393
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Entity Type | Organization
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Legal Business Name | M. FREEMAN MEDICAL PRACTICE, P.C.
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 407 W 147TH ST
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City | NEW YORK
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State | NY
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Zip | 10031-4808
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Country | US
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Telephone | 212-281-5613
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Fax | 212-862-4923
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Provider Business Mailing Address
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Address Line | 407 W 147TH ST
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City | NEW YORK
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State | NY
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Zip | 10031-4808
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Country | US
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Telephone | 212-281-5613
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Fax | 212-862-4923
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Authorized Official
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Title or Position | AUTHORIZE OFFICIAL
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Name | MELISSA M FREEMAN
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Credential | MD
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Telephone | 917-864-0708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 080452
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 080452
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License Number State | NY
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