Provider Demographics
NPI:1033170931
Name:FRIEDMAN, GARY SETH (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SETH
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BROOKDALE PLAZA
Mailing Address - Street 2:PHYSICIAN ENTERPRISE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3139
Mailing Address - Country:US
Mailing Address - Phone:718-240-7143
Mailing Address - Fax:718-240-5808
Practice Address - Street 1:ONE BROOKDALE PLAZA
Practice Address - Street 2:OBH PHYSICIAN ENTERPRISE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-1121
Practice Address - Country:US
Practice Address - Phone:718-240-5622
Practice Address - Fax:718-240-5808
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL157932084N0400X, 208100000X
OK170792084N0400X, 208100000X
MO1049752084N0400X, 208100000X
WV188622084N0400X, 208100000X
NY1446742084N0400X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
0551089OtherCIGNA
GF52693861OtherAPP ONE
000000077372OtherGHI
5850533OtherAETNA OUT OF NETWORK
0551089OtherCIGNA
000000077372OtherGHI