Provider Demographics
NPI:1659474104
Name:FREID, ROBERT SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SAUL
Last Name:FREID
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 1:205 RIDGEDALE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1349
Mailing Address - Country:US
Mailing Address - Phone:973-377-0164
Mailing Address - Fax:973-377-0063
Practice Address - Street 1:205 RIDGEDALE AVENUE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1349
Practice Address - Country:US
Practice Address - Phone:973-377-0164
Practice Address - Fax:973-377-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04544000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1957201Medicaid
FR461817Medicare ID - Type Unspecified
NJ1957201Medicaid