Provider Demographics
NPI:1093781759
Name:FREISTAT, NAOMI I (DPM)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:I
Last Name:FREISTAT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 WEST END AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:212-362-9110
Mailing Address - Fax:212-873-1570
Practice Address - Street 1:185 WEST END AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:212-362-9110
Practice Address - Fax:212-873-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN39861213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0083278OtherGHI
NY01363684Medicaid
PB9521Medicare ID - Type Unspecified
U81610Medicare UPIN