Provider Demographics
NPI:1407840986
Name:FRIEDMAN, ELI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELI
Middle Name:A
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 1262
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-8867
Mailing Address - Fax:718-270-1794
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1585
Practice Address - Fax:718-270-3327
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080904-1207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00202020Medicaid
NY197671Medicare ID - Type Unspecified
NY00202020Medicaid