Provider Demographics
NPI:1265869077
Name:PHILIP FRIED MD PLLC
Entity type:Organization
Organization Name:PHILIP FRIED MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-949-6070
Mailing Address - Street 1:20 OLD MAMARONECK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2060
Mailing Address - Country:US
Mailing Address - Phone:914-949-6070
Mailing Address - Fax:914-949-4560
Practice Address - Street 1:20 OLD MAMARONECK RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2060
Practice Address - Country:US
Practice Address - Phone:914-949-6070
Practice Address - Fax:914-949-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160340207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty