Provider Demographics
NPI:1346518644
Name:JEFFREY S FRIELING MD PC
Entity Type:Organization
Organization Name:JEFFREY S FRIELING MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:EDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-295-3862
Mailing Address - Street 1:10 AUERBACH LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-2517
Mailing Address - Country:US
Mailing Address - Phone:516-284-7164
Mailing Address - Fax:516-284-7164
Practice Address - Street 1:9016 ROCKAWAY BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1530
Practice Address - Country:US
Practice Address - Phone:718-318-1155
Practice Address - Fax:516-284-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172713-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
75165OtherPTAN