Provider Demographics
NPI:1902854821
Name:FRIEDMAN, LARRY (PA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 77TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1850
Mailing Address - Country:US
Mailing Address - Phone:917-776-0923
Mailing Address - Fax:212-434-4512
Practice Address - Street 1:100 E 77TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1850
Practice Address - Country:US
Practice Address - Phone:212-434-3042
Practice Address - Fax:212-434-4512
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01981671Medicaid
NY0F42823051Medicare PIN
NYA400007769Medicare PIN
NY0F4282Medicare PIN
S87685Medicare UPIN