Provider Demographics
NPI:1073067393
Name:M. FREEMAN MEDICAL PRACTICE, P.C.
Entity Type:Organization
Organization Name:M. FREEMAN MEDICAL PRACTICE, P.C.
Other - Org Name:MELISS M. FREEMAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZE OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-864-0708
Mailing Address - Street 1:407 W 147TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4808
Mailing Address - Country:US
Mailing Address - Phone:212-281-5613
Mailing Address - Fax:212-862-4923
Practice Address - Street 1:407 W 147TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4808
Practice Address - Country:US
Practice Address - Phone:212-281-5613
Practice Address - Fax:212-862-4923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MELISS M. FREEMAN, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080452261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00591020Medicaid
NY00591020Medicaid