Provider Demographics
NPI:1629735568
Name:FRIEDMAN, CARLY ISABELLE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CARLY
Middle Name:ISABELLE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 95TH ST APT 10D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4004
Mailing Address - Country:US
Mailing Address - Phone:216-990-9667
Mailing Address - Fax:
Practice Address - Street 1:225 E 95TH ST APT 10D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4004
Practice Address - Country:US
Practice Address - Phone:216-990-9667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY030391-01363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program