Provider Demographics
NPI:1306840038
Name:FRIEDMAN, CARL BERTRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:BERTRAM
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 1:123 MAPLE AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 MAPLE AVE
Practice Address - Street 2:STE 203
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2240
Practice Address - Country:US
Practice Address - Phone:516-374-1818
Practice Address - Fax:516-374-1830
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2009-12-22
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
NY106697207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00187320Medicaid
NYB77871Medicare UPIN