Provider Demographics
NPI:1598803298
Name:FRIED, ALAN MARK (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:MARK
Last Name:FRIED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 87TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4916
Mailing Address - Country:US
Mailing Address - Phone:718-836-9138
Mailing Address - Fax:718-836-9032
Practice Address - Street 1:144 87TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4916
Practice Address - Country:US
Practice Address - Phone:718-836-9138
Practice Address - Fax:718-836-9032
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist