Provider Demographics
NPI:1073513545
Name:FRIEDLANDER, MARVIN ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:ELLIOTT
Last Name:FRIEDLANDER
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 1:700 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6634
Mailing Address - Country:US
Mailing Address - Phone:908-688-1999
Mailing Address - Fax:908-688-8180
Practice Address - Street 1:700 RAHWAY AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6634
Practice Address - Country:US
Practice Address - Phone:908-688-1999
Practice Address - Fax:908-688-8180
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05251300207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0621501Medicaid
NJ223537990OtherTAX ID
NJE22104Medicare UPIN
NJ0621501Medicaid