Provider Demographics
NPI:1518671833
Name:FREEMAN, BRYAN DWAYNE
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DWAYNE
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 48TH ST APT 3RS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-1101
Mailing Address - Country:US
Mailing Address - Phone:323-474-2202
Mailing Address - Fax:
Practice Address - Street 1:1980 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2525
Practice Address - Country:US
Practice Address - Phone:718-597-1587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist