Provider Demographics
NPI:1093969768
Name:FRIEDMAN, NINA IVY (MACCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:IVY
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:MACCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 BELL BLVD
Mailing Address - Street 2:BAYSIDE, N.Y.
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1642
Mailing Address - Country:US
Mailing Address - Phone:917-601-8562
Mailing Address - Fax:718-423-7567
Practice Address - Street 1:1806 BELL BLVD
Practice Address - Street 2:BAYSIDE N.Y.
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1642
Practice Address - Country:US
Practice Address - Phone:917-601-8562
Practice Address - Fax:718-423-7567
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-07
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007284-1235Z00000X
NYREG #5941545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist