Provider Demographics
NPI:1457834327
Name:FRIEDMAN ORTHODONTICS
Entity Type:Organization
Organization Name:FRIEDMAN ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHOLOM
Authorized Official - Middle Name:DOVID
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-667-1984
Mailing Address - Street 1:201 MEETING HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1211
Mailing Address - Country:US
Mailing Address - Phone:610-617-9529
Mailing Address - Fax:610-667-2438
Practice Address - Street 1:101 PROSPECT ST STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5003
Practice Address - Country:US
Practice Address - Phone:610-667-1984
Practice Address - Fax:610-667-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021863001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1376664979OtherNPI