Provider Demographics
NPI:1376818377
Name:FRIED, DEREK LEWIS (VMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:LEWIS
Last Name:FRIED
Suffix:
Gender:M
Credentials:VMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 RIVERDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1805
Mailing Address - Country:US
Mailing Address - Phone:718-796-8387
Mailing Address - Fax:718-432-6302
Practice Address - Street 1:3607 RIVERDALE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1805
Practice Address - Country:US
Practice Address - Phone:718-796-8387
Practice Address - Fax:718-432-6302
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian