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General NPI Number Information
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NPI Number | 1427294826
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Entity Type | Individual
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Provider Name | PHILIP BRIAN FREED PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 111 CENTRAL AVE SAINT MICHAEL'S MEDICAL CENTER - DIV OF CARDIAC SURGERY
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City | NEWARK
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State | NJ
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Zip | 07102-1909
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Country | US
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Telephone | 973-877-2327
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Fax |
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Provider Business Mailing Address
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Address Line | 1 SMITH RD
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City | FLEMINGTON
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State | NJ
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Zip | 08822-7300
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Country | US
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Telephone | 908-823-4049
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Fax | 908-534-6475
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00077100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 005611
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License Number State | NY
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