Provider Demographics
NPI:1346281177
Name:FREILICH, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:FREILICH
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 1:389 BEECHMONT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-4617
Mailing Address - Country:US
Mailing Address - Phone:914-576-6084
Mailing Address - Fax:914-576-6084
Practice Address - Street 1:389 BEECHMONT DR
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-4617
Practice Address - Country:US
Practice Address - Phone:914-576-6084
Practice Address - Fax:914-576-6084
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11354275OtherCAQH
NYD91630Medicare UPIN
NY286691Medicare ID - Type Unspecified
NY00248417Medicare ID - Type Unspecified