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General NPI Number Information
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NPI Number | 1306890165
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Entity Type | Individual
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Provider Name | IVAN A FRIEDRICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 420 GRAND AVE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4152
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Country | US
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Telephone | 201-569-7044
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Fax | 201-569-1999
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Provider Business Mailing Address
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Address Line | 420 GRAND AVE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4152
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Country | US
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Telephone | 201-569-7044
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Fax | 201-569-1999
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA03997000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 134313-1
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License Number State | NY
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