Provider Demographics
NPI:1710141338
Name:FRIEDMAN, ILANA SARA (PH D)
Entity Type:Individual
Prefix:DR
First Name:ILANA
Middle Name:SARA
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1555
Mailing Address - Country:US
Mailing Address - Phone:516-773-4876
Mailing Address - Fax:516-482-0716
Practice Address - Street 1:56 CAMBRIDGE RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-1555
Practice Address - Country:US
Practice Address - Phone:516-773-4876
Practice Address - Fax:516-482-0716
Is Sole Proprietor?:No
Enumeration Date:2008-07-13
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5605103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
39433OtherGHI MEDICARE PIN
NY00913222Medicaid
NYV27251Medicare UPIN