Provider Demographics
NPI:1689985319
Name:FRIED, DEBORAH NAOMI
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:NAOMI
Last Name:FRIED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 PLAINVIEW AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5519
Mailing Address - Country:US
Mailing Address - Phone:718-327-7462
Mailing Address - Fax:
Practice Address - Street 1:1109 PLAINVIEW AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5519
Practice Address - Country:US
Practice Address - Phone:718-327-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY565596-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse