Provider Demographics
NPI:1700810678
Name:FRIEDMAN, ROBERT T (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 W GENESEE ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-1528
Mailing Address - Country:US
Mailing Address - Phone:315-510-3677
Mailing Address - Fax:315-510-3683
Practice Address - Street 1:153 W GENESEE ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1528
Practice Address - Country:US
Practice Address - Phone:315-510-3677
Practice Address - Fax:315-510-3683
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00821816Medicaid
NY110201609Medicare PIN
NY00821816Medicaid
NYBB9383Medicare PIN