Provider Demographics
NPI:1265592976
Name:FRIED, JOEL R (DDS)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:R
Last Name:FRIED
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 1:9 WASHINGTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3740
Mailing Address - Country:US
Mailing Address - Phone:845-639-1902
Mailing Address - Fax:845-354-8470
Practice Address - Street 1:5C MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3516
Practice Address - Country:US
Practice Address - Phone:845-354-1655
Practice Address - Fax:845-354-8470
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0029305122300000X
NJ22DI00898400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00325219Medicaid