Provider Demographics
NPI:1124023155
Name:FREEDMAN, ALAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5303
Mailing Address - Country:US
Mailing Address - Phone:516-487-6700
Mailing Address - Fax:516-487-6877
Practice Address - Street 1:885 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5303
Practice Address - Country:US
Practice Address - Phone:516-487-6700
Practice Address - Fax:516-487-6877
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177419208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY49F181OtherMEDICARE PIN (EMPIRE GOVERNMENT SERVICES)
NY03211OtherMEDICARE PIN (GHI)
NYE44907Medicare UPIN