Provider Demographics
NPI:1871815670
Name:FREIBERG, STANLEY L I
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:L
Last Name:FREIBERG
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 87TH ST APT 4F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4806
Mailing Address - Country:US
Mailing Address - Phone:212-722-0914
Mailing Address - Fax:
Practice Address - Street 1:4159 WHITE PLAINS RD
Practice Address - Street 2:THE BRONX
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3021
Practice Address - Country:US
Practice Address - Phone:718-405-1394
Practice Address - Fax:718-653-0278
Is Sole Proprietor?:No
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY021068OtherPHARMACY LICENSE