Provider Demographics
NPI:1881762029
Name:FREEMAN, TED L (DO)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:L
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:186 JACK MARTIN BLVD
Mailing Address - Street 2:SUITE B1
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-785-1600
Mailing Address - Fax:732-785-1642
Practice Address - Street 1:186 JACK MARTIN BLVD
Practice Address - Street 2:SUITE B1
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-785-1600
Practice Address - Fax:732-785-1642
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB061100002081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8067503Medicaid
NJ8067503Medicaid
NJG61636Medicare UPIN