Provider Demographics
NPI:1093984577
Name:HARVEY A FREEDMAN DPM PC
Entity Type:Organization
Organization Name:HARVEY A FREEDMAN DPM PC
Other - Org Name:HAUPPAUGE PODIATRY ASSOCIATES SACHEM FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:COOMBS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-724-8285
Mailing Address - Street 1:154 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5103
Mailing Address - Country:US
Mailing Address - Phone:631-724-8285
Mailing Address - Fax:631-724-1598
Practice Address - Street 1:154 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5103
Practice Address - Country:US
Practice Address - Phone:631-724-8285
Practice Address - Fax:631-724-1598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3917040001Medicare NSC