Provider Demographics
NPI:1801858055
Name:FRID, GENYA (MD)
Entity Type:Individual
Prefix:
First Name:GENYA
Middle Name:
Last Name:FRID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:410 LAKEVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042
Mailing Address - Country:US
Mailing Address - Phone:516-488-9700
Mailing Address - Fax:516-488-8826
Practice Address - Street 1:410 LAKEVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042
Practice Address - Country:US
Practice Address - Phone:516-488-9700
Practice Address - Fax:516-488-8826
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2011-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY159734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD93243Medicare UPIN
NY36E581Medicare PIN