Provider Demographics
NPI:1720255177
Name:FRIEDMAN, SUSAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6701
Mailing Address - Country:US
Mailing Address - Phone:212-371-8452
Mailing Address - Fax:212-421-0020
Practice Address - Street 1:310 E 52ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6701
Practice Address - Country:US
Practice Address - Phone:212-371-8452
Practice Address - Fax:212-421-0020
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0325631223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics