Provider Demographics
NPI:1912013087
Name:FRIEDMAN, RORY J (DPM)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:J
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:STE #807
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813
Mailing Address - Country:US
Mailing Address - Phone:562-437-3338
Mailing Address - Fax:562-437-1919
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:STE #807
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-437-3338
Practice Address - Fax:562-437-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3644213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36440Medicaid
T91743Medicare UPIN
CAE3644Medicare ID - Type Unspecified
CA0903180001Medicare NSC