Provider Demographics
NPI:1003086661
Name:HARVEY A FREEDMAN DPM PC
Entity Type:Organization
Organization Name:HARVEY A FREEDMAN DPM PC
Other - Org Name:HAUPPAUSE PODIATRY ASSOCIATES SACHEN FOOT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-467-7600
Mailing Address - Street 1:276 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-2043
Mailing Address - Country:US
Mailing Address - Phone:631-467-7600
Mailing Address - Fax:631-467-0945
Practice Address - Street 1:279 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-2043
Practice Address - Country:US
Practice Address - Phone:631-467-7600
Practice Address - Fax:631-467-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3917040002Medicare NSC