Provider Demographics
NPI:1679696827
Name:DR. Z. B. FRIEDENBERG ORTH SURGERY PC
Entity Type:Organization
Organization Name:DR. Z. B. FRIEDENBERG ORTH SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:BERT
Authorized Official - Last Name:FRIEDENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-386-4990
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:1ST FLOOR CUPP BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-386-4990
Mailing Address - Fax:215-662-5978
Practice Address - Street 1:51 N 39TH ST
Practice Address - Street 2:1ST FLOOR CUPP BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-386-4990
Practice Address - Fax:215-662-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD002704E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0060372004Medicaid
PA0060372004Medicaid