Provider Demographics
NPI:1033195391
Name:FREID, RUSSELL M (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:M
Last Name:FREID
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 DIAMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:
Practice Address - Street 1:2 PRINCESS RD STE J
Practice Address - Street 2:LAWRENCEVILLE UROLOGY
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2320
Practice Address - Country:US
Practice Address - Phone:609-895-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06682466824208800000X
NJ25MA06682400208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7636504Medicaid
006131CJ9Medicare ID - Type Unspecified
NJ7636504Medicaid