Provider Demographics
NPI:1083877948
Name:FREED, SCHERZ, KLEINBERG, NUSSBAUM & FESTA, MD, LLP
Entity Type:Organization
Organization Name:FREED, SCHERZ, KLEINBERG, NUSSBAUM & FESTA, MD, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHADE
Authorized Official - Suffix:
Authorized Official - Credentials:ETC
Authorized Official - Phone:631-588-7973
Mailing Address - Street 1:1270 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-727-8080
Mailing Address - Fax:631-727-6803
Practice Address - Street 1:270 UNION AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1823
Practice Address - Country:US
Practice Address - Phone:631-588-7973
Practice Address - Fax:631-471-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125799-1173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00656762Medicaid
NY7B3721Medicaid
NY00306170Medicaid
NY01281718Medicaid
NY00765857Medicaid
NY02256857Medicaid
NY02971039Medicaid
NY02559680Medicaid
NY00657209Medicaid