Provider Demographics
NPI:1831298488
Name:FREILICH, BENJAMIN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:FREILICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 ELKWOOD TER
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-1937
Mailing Address - Country:US
Mailing Address - Phone:212-203-3852
Mailing Address - Fax:
Practice Address - Street 1:15 ENGLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2936
Practice Address - Country:US
Practice Address - Phone:201-871-9595
Practice Address - Fax:201-871-2323
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA73950207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8883807Medicaid
NJF65321Medicare UPIN
NY72T151Medicare ID - Type Unspecified
NJ8883807Medicaid
NJ146770Medicare PIN