Provider Demographics
NPI:1457468746
Name:FRIEDRICH, JOSEPH M JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:FRIEDRICH
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 LAKEWOOD AVE
Mailing Address - Street 2:GCU - ATHLETIC TRAINING
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2600
Mailing Address - Country:US
Mailing Address - Phone:732-987-2687
Mailing Address - Fax:732-987-2031
Practice Address - Street 1:900 LAKEWOOD AVE
Practice Address - Street 2:GCU - ATHLETIC TRAINING
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2600
Practice Address - Country:US
Practice Address - Phone:732-987-2687
Practice Address - Fax:732-987-2031
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MR001279002255A2300X
PART0039162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer