MEDICARE: DR. DEREK LEWIS FRIED V.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174M00000X	Veterinarian

General Provider Information

NPI Number	:	1376818377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEREK LEWIS FRIED V.M.D

Provider Business Mailing Address
First Line	:	3607 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1805
Country	:	US
Telephone Number	:	718-796-8387
Fax Number	:	718-432-6302

Provider Business Practice Location Address
First Line	:	3607 RIVERDALE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-1805
Country	:	US
Telephone Number	:	718-796-8387
Fax Number	:	718-432-6302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2012
Last Update Date	:	03/09/2012

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