Provider Demographics
NPI:1770678773
Name:FRIEDMAN, BRUCE LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:LEE
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S MARGINAL RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1914
Mailing Address - Country:US
Mailing Address - Phone:516-937-3409
Mailing Address - Fax:516-932-8743
Practice Address - Street 1:430 S MARGINAL RD
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1914
Practice Address - Country:US
Practice Address - Phone:516-937-3409
Practice Address - Fax:516-932-8743
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400058122OtherMEDICARE PTAN
NYT52459Medicare UPIN