Provider Demographics
NPI:1558406157
Name:FRIDMAN, RICHARD NEIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEIL
Last Name:FRIDMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1411
Mailing Address - Country:US
Mailing Address - Phone:516-367-4003
Mailing Address - Fax:516-367-4007
Practice Address - Street 1:136 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1411
Practice Address - Country:US
Practice Address - Phone:516-367-4003
Practice Address - Fax:516-367-4007
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics