Provider Demographics
NPI:1639221450
Name:FRIEDMAN, MARK BRIAN (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRIAN
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:SLINGERLANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12159-0125
Mailing Address - Country:US
Mailing Address - Phone:518-482-4321
Mailing Address - Fax:518-482-4664
Practice Address - Street 1:6 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3791
Practice Address - Country:US
Practice Address - Phone:518-482-4321
Practice Address - Fax:518-482-4664
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005533-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC0690Medicare PIN