Provider Demographics
NPI:1699196055
Name:GAVIN FRIEDMAN MD P.C
Entity Type:Organization
Organization Name:GAVIN FRIEDMAN MD P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-607-1255
Mailing Address - Street 1:410 CENTRAL PARK W
Mailing Address - Street 2:17F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4819
Mailing Address - Country:US
Mailing Address - Phone:917-607-1255
Mailing Address - Fax:815-550-1734
Practice Address - Street 1:15 W 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4507
Practice Address - Country:US
Practice Address - Phone:917-607-1255
Practice Address - Fax:815-550-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03019129Medicaid
NYA300034341Medicare PIN