Provider Demographics
NPI:1134395379
Name:FRIEDMAN, ISAAC (DDS)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:FRIEDMAN
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 1:2161 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6603
Mailing Address - Country:US
Mailing Address - Phone:718-982-5440
Mailing Address - Fax:718-982-5446
Practice Address - Street 1:2161 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6603
Practice Address - Country:US
Practice Address - Phone:718-982-5440
Practice Address - Fax:718-982-5446
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0348171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice