Provider Demographics
NPI:1619034212
Name:JERALD N FRIEDMAN MD PC
Entity Type:Organization
Organization Name:JERALD N FRIEDMAN MD PC
Other - Org Name:JERALD N FRIEDMAN MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-250-0800
Mailing Address - Street 1:2531 NORTHAMPTON STREET
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045
Mailing Address - Country:US
Mailing Address - Phone:610-250-0800
Mailing Address - Fax:610-250-7802
Practice Address - Street 1:2531 NORTHAMPTON STREET
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045
Practice Address - Country:US
Practice Address - Phone:610-250-0800
Practice Address - Fax:610-250-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0094515E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
03022600OtherCAPITALBLUECROSS
03022600OtherCAPITALBLUECROSS
=========0OtherHORIZON BLUE SHIELD
=========0OtherUNITED AMERICAN INS
NJ627667Medicare ID - Type Unspecified
03022600OtherCAPITALBLUECROSS
PA017611Medicare ID - Type Unspecified