Provider Demographics
NPI:1922170356
Name:DR.JEROME T. FRIEDMAN
Entity Type:Organization
Organization Name:DR.JEROME T. FRIEDMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:T
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-371-9085
Mailing Address - Street 1:800A 5TH AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-7215
Mailing Address - Country:US
Mailing Address - Phone:212-371-9085
Mailing Address - Fax:212-486-6955
Practice Address - Street 1:800A 5TH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-7215
Practice Address - Country:US
Practice Address - Phone:212-371-9085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023857261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery