Provider Demographics
NPI:1225198138
Name:FRIEDMAN, SIMON H (MD)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:H
Last Name:FRIEDMAN
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 1:1636 EAST 14TH STR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-339-2300
Mailing Address - Fax:718-998-8020
Practice Address - Street 1:1636 EAST 14TH STR
Practice Address - Street 2:SUITE 120
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-339-2300
Practice Address - Fax:718-998-8020
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134959207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00762001Medicaid
B80498Medicare UPIN
NY00762001Medicaid