MEDICARE: MINDY FRIED CD(DONA)

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1578930657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY FRIED CD(DONA)

Provider Business Mailing Address
First Line	:	23 NILES PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5025
Country	:	US
Telephone Number	:	718-494-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NILES PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-5025
Country	:	US
Telephone Number	:	718-494-4343
Fax Number	:

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

Provider Enumeration Date	:	08/25/2015
Last Update Date	:	08/25/2015

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Directions to “ MINDY FRIED CD(DONA)” Practice Location

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