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NPI Code Detail

MEDICARE: DR. GREGORY S. FREED D.D.S

MEDICARE: DR. GREGORY S. FREED 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
11223G0001XGeneral Practice DentistryDI021382NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11223G0001XOTHERNJTAXONOMY
2DI021382OTHERNJSTATE LICENSE

General Provider Information

NPI Number : 1972506889
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY S. FREED D.D.S
Provider Business Mailing Address
First Line : 24 VISTA RD
Second Line :
City : MONTVILLE
State : NJ
Zip : 07045-9206
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 38 MEADOWLANDS PKWY
Second Line :
City : SECAUCUS
State : NJ
Zip : 07094-2925
Country : US
Telephone Number : 201-864-4700
Fax Number : 201-864-0197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 07/08/2007

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