Provider Demographics
NPI:1508935875
Name:FRIEDMAN, JAMES MARC (ANP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARC
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 MAYFAIR AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2350
Mailing Address - Country:US
Mailing Address - Phone:516-488-4017
Mailing Address - Fax:
Practice Address - Street 1:166 MAYFAIR AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2350
Practice Address - Country:US
Practice Address - Phone:516-488-4017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1016363LA2200X
NYF303060363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP0052Medicaid
NY00246075Medicaid
AKNP0052Medicaid