Provider Demographics
NPI:1841249497
Name:FRIEDMAN, JERROLD A (MD)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:A
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:PO BOX 1272
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-7272
Mailing Address - Country:US
Mailing Address - Phone:856-755-1616
Mailing Address - Fax:856-755-1616
Practice Address - Street 1:3001 E EVESHAM RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-9547
Practice Address - Country:US
Practice Address - Phone:856-751-1600
Practice Address - Fax:856-751-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2017-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06914500208100000X
PAMD067120L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0343567000OtherAMERIHEALTH HMO
NJ1155963OtherHORIZON NJ HEALTH
568292OtherPA BLUE SHIELD NJ PATIENT
30021071OtherKEYSTONE MERCY
NJ7961103Medicaid
FR1648250OtherHIGHMARK BCBS
PA250013591OtherRAILROAD MEDICARE
NJ250013827OtherRAILROAD MEDICARE
NJ568292OtherAMERIHEALTH PERSONAL CHOI
NY212261OtherEMPIRE BCBS
NJ2672520OtherAETNA HMO
NJ5365751OtherAETNA PPO
NJ250013827OtherRAILROAD MEDICARE
NJ5365751OtherAETNA PPO
NJG95218Medicare UPIN