Provider Demographics
NPI:1114087889
Name:FRIEDMAN, A J (OD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:J
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:229 EAST MT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0000
Mailing Address - Country:US
Mailing Address - Phone:973-992-0612
Mailing Address - Fax:973-992-3738
Practice Address - Street 1:1767 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3532
Practice Address - Country:US
Practice Address - Phone:908-964-6046
Practice Address - Fax:908-687-7956
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJNJ3466152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0730203Medicaid
NJ0730203Medicaid
NJB63229Medicare UPIN