Provider Demographics
NPI:1235305442
Name:GARY R FRIEDMAN MD PC
Entity Type:Organization
Organization Name:GARY R FRIEDMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-621-5249
Mailing Address - Street 1:1044 NORTHERN BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1514
Mailing Address - Country:US
Mailing Address - Phone:516-621-5249
Mailing Address - Fax:516-621-5264
Practice Address - Street 1:1044 NORTHERN BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1514
Practice Address - Country:US
Practice Address - Phone:516-621-5249
Practice Address - Fax:516-621-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142901207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY17D49EW731Medicare PIN
NYC06232Medicare UPIN
NYWZPZQ1Medicare PIN