MEDICARE: MICHAEL FRIED MD

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	174400000X	Specialist	128126	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851395628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FRIED MD

Provider Business Mailing Address
First Line	:	235 N BELLE MEAD RD
Second Line	:
City	:	E SETAUKET
State	:	NY
Zip	:	11733-3456
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-751-3366

Provider Business Practice Location Address
First Line	:	285 SILLS RD
Second Line	:	BLDG 16
City	:	EAST PATCHOGUE
State	:	NY
Zip	:	11772-4808
Country	:	US
Telephone Number	:	631-758-7575
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	12/19/2007

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