Provider Demographics
NPI:1821213729
Name:FRIEDMAN, MICHAEL C (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CEDAR LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4315
Mailing Address - Country:US
Mailing Address - Phone:201-220-5336
Mailing Address - Fax:973-403-8657
Practice Address - Street 1:175 CEDAR LN
Practice Address - Street 2:STE 7
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4315
Practice Address - Country:US
Practice Address - Phone:201-220-5336
Practice Address - Fax:973-403-8657
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000986001041C0700X
NYR013380-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223607770OtherFEDERAL TAX ID
NY223607770OtherFEDERAL TAX ID
NYR46204Medicare UPIN
NYN03061Medicare ID - Type UnspecifiedNY MEDICARE PROVIDER
NJR46204Medicare UPIN
NJ223607770OtherFEDERAL TAX ID