Provider Demographics
NPI:1912101478
Name:JEFFREY P. FRIEDMAN MD
Entity Type:Organization
Organization Name:JEFFREY P. FRIEDMAN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-270-7592
Mailing Address - Street 1:54 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2358
Mailing Address - Country:US
Mailing Address - Phone:203-270-7592
Mailing Address - Fax:203-270-0420
Practice Address - Street 1:54 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2358
Practice Address - Country:US
Practice Address - Phone:203-270-7592
Practice Address - Fax:203-270-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1229228Medicaid
CT1229228Medicaid
CTC59558Medicare UPIN