Provider Demographics
NPI:1518102748
Name:FRIED, AVIVA (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:AVIVA
Middle Name:
Last Name:FRIED
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18443 MIDLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1527
Mailing Address - Country:US
Mailing Address - Phone:718-591-5951
Mailing Address - Fax:
Practice Address - Street 1:18443 MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1527
Practice Address - Country:US
Practice Address - Phone:718-591-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009924-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist