Provider Demographics
NPI:1710240668
Name:FRIEDMAN, MEGHAN MARIE (BA)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:MARIE
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:MARIE
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 N EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2011
Mailing Address - Country:US
Mailing Address - Phone:631-561-3781
Mailing Address - Fax:
Practice Address - Street 1:85 N EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2011
Practice Address - Country:US
Practice Address - Phone:631-561-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1128671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist