Provider Demographics
NPI:1477675122
Name:FRIEDMAN, ELENA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:M
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:M
Other - Last Name:GALDAU-FRIEDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1 SNOWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3051
Mailing Address - Country:US
Mailing Address - Phone:516-672-2571
Mailing Address - Fax:
Practice Address - Street 1:1626 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1640
Practice Address - Country:US
Practice Address - Phone:718-423-1210
Practice Address - Fax:718-279-2356
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist