Provider Demographics
NPI:1417907361
Name:FRIEDMAN, AMIR MORDECHAI (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:MORDECHAI
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 RAVENSWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2927
Mailing Address - Country:US
Mailing Address - Phone:856-676-6558
Mailing Address - Fax:
Practice Address - Street 1:475 ROUTE 70 STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5897
Practice Address - Country:US
Practice Address - Phone:732-449-9900
Practice Address - Fax:732-449-4407
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
NJ25MA08146400207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0116122Medicaid
NJ104725Medicare PIN
G96399Medicare UPIN