Provider Demographics
NPI:1609078278
Name:FRIDMAN, YULY (L AC)
Entity Type:Individual
Prefix:MR
First Name:YULY
Middle Name:
Last Name:FRIDMAN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25344 61ST AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2431
Mailing Address - Country:US
Mailing Address - Phone:718-612-1933
Mailing Address - Fax:
Practice Address - Street 1:10206 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6732
Practice Address - Country:US
Practice Address - Phone:718-612-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002864171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3509609OtherOXFORD