Provider Demographics
NPI:1275525040
Name:FRIED, HARLEE A (DO)
Entity Type:Individual
Prefix:
First Name:HARLEE
Middle Name:A
Last Name:FRIED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RYKOWSKI LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4018
Mailing Address - Country:US
Mailing Address - Phone:845-692-3376
Mailing Address - Fax:845-692-0124
Practice Address - Street 1:28 RYKOWSKI LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4018
Practice Address - Country:US
Practice Address - Phone:845-692-3376
Practice Address - Fax:845-692-0124
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010268207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001780659 0002Medicaid
NY1475841Medicaid
PA001780659 0002Medicaid
E81196Medicare UPIN
NY1475841Medicaid