Provider Demographics
NPI:1700229788
Name:FRIEDLAND, MORDECHAI
Entity Type:Individual
Prefix:
First Name:MORDECHAI
Middle Name:
Last Name:FRIEDLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 BEACH 127TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1728
Mailing Address - Country:US
Mailing Address - Phone:845-709-9269
Mailing Address - Fax:
Practice Address - Street 1:241 BEACH 127TH ST FL 3
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1728
Practice Address - Country:US
Practice Address - Phone:845-709-9269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4063101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor