MEDICARE: DR. LEON FRIEDMAN D.D.S.

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	1223G0001X	General Practice Dentistry	22D100795500	NJ

General Provider Information

NPI Number	:	1962626515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON FRIEDMAN D.D.S.

Provider Business Mailing Address
First Line	:	10 PLAINFIELD AVE
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-4046
Country	:	US
Telephone Number	:	732-457-8855
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 PLAINFIELD AVE
Second Line	:
City	:	PISCATAWAY
State	:	NJ
Zip	:	08854-4046
Country	:	US
Telephone Number	:	732-457-8855
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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