Provider Demographics
NPI:1659455194
Name:FRIEDMAN, JERALD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:S
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CEDAR LN
Mailing Address - Street 2:2ND FL
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3442
Mailing Address - Country:US
Mailing Address - Phone:201-692-7737
Mailing Address - Fax:
Practice Address - Street 1:315 CEDAR LN
Practice Address - Street 2:2ND FL
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3442
Practice Address - Country:US
Practice Address - Phone:201-692-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI017789001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ772348Medicare ID - Type Unspecified
NJU31172Medicare UPIN