Provider Demographics
NPI:1407587736
Name:FREDMAN, ANIELLE M (MPHIL)
Entity Type:Individual
Prefix:
First Name:ANIELLE
Middle Name:M
Last Name:FREDMAN
Suffix:
Gender:F
Credentials:MPHIL
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:M
Other - Last Name:FREDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPHIL
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-5024
Mailing Address - Fax:718-798-1816
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-5024
Practice Address - Fax:718-798-1816
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program