Provider Demographics
NPI:1851507156
Name:FREEDMAN, GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:FREEDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 RTE. 300
Mailing Address - Street 2:STE. 1081
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3029
Mailing Address - Country:US
Mailing Address - Phone:845-564-9300
Mailing Address - Fax:845-564-9307
Practice Address - Street 1:1401 ROUTE 300
Practice Address - Street 2:STE. 1081
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2990
Practice Address - Country:US
Practice Address - Phone:845-564-9300
Practice Address - Fax:845-564-9307
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037051122300000X
NJDI013761001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice