Provider Demographics
NPI:1700905072
Name:FRIEDMAN, MARY P (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAUREL OAK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3518
Mailing Address - Country:US
Mailing Address - Phone:856-435-8842
Mailing Address - Fax:856-435-6301
Practice Address - Street 1:1020 LAUREL OAK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3518
Practice Address - Country:US
Practice Address - Phone:856-435-8842
Practice Address - Fax:856-435-6301
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26MJ00008100363L00000X
NJ26NJ00008100363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ080472Medicare ID - Type Unspecified