Provider Demographics
NPI:1669447587
Name:FRIEDMAN, JAY LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:LAWRENCE
Last Name:FRIEDMAN
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 1:2 DEAN DRIVE
Mailing Address - Street 2:1ST FLOOR SOUTH WING
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2765
Mailing Address - Country:US
Mailing Address - Phone:201-568-8288
Mailing Address - Fax:201-568-8105
Practice Address - Street 1:111 DEAN DRIVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670
Practice Address - Country:US
Practice Address - Phone:201-568-8288
Practice Address - Fax:201-568-8105
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0689962084P0800X
NY2043852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8177708Medicaid
NJ035845Medicare ID - Type Unspecified
G99262Medicare UPIN
NY73M301Medicare ID - Type Unspecified