Provider Demographics
NPI:1609814870
Name:FRIEDENTHAL, ROY B (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:B
Last Name:FRIEDENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 COMMERCE LN STE 3
Mailing Address - Street 2:
Mailing Address - City:WEST BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08091-2513
Mailing Address - Country:US
Mailing Address - Phone:856-767-8787
Mailing Address - Fax:856-767-6140
Practice Address - Street 1:403 COMMERCE LN STE 3
Practice Address - Street 2:
Practice Address - City:WEST BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08091-2513
Practice Address - Country:US
Practice Address - Phone:856-767-8787
Practice Address - Fax:856-767-6140
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ33179207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0447200Medicaid
NJ067649BYHMedicare PIN
NJC63211Medicare UPIN