Provider Demographics
NPI:1811052681
Name:FRIDMAN, MARSHA (NP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:FRIDMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:370 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3176
Mailing Address - Country:US
Mailing Address - Phone:718-833-7246
Mailing Address - Fax:718-833-0033
Practice Address - Street 1:370 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3176
Practice Address - Country:US
Practice Address - Phone:718-833-7246
Practice Address - Fax:718-833-0033
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301071Medicaid