Provider Demographics
NPI:1366492126
Name:GRETZ FRIEDMAN, ELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:
Last Name:GRETZ FRIEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:2ND FLOOR BOX 1174
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-7952
Mailing Address - Fax:212-241-1238
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-7952
Practice Address - Fax:212-241-1238
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164472207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3373811OtherAETNA HMO
NY02312398Medicaid
NY7176533OtherAETNA PPO
NYP3060599OtherOXFORD/FREEDOM/MEDICARE
NY1534753OtherUHC/HMO/POS/PPO/EPO/INDEM
NY52Z721OtherEMPIRE HMOPPO/POS/INDEMN
NY1443044OtherCIGNA/PPO/POS/HMO/INDEMN
NY52Z721Medicare ID - Type Unspecified
NY52Z721OtherEMPIRE HMO?PPO/POS/INDEMN