Provider Demographics
NPI:1073688438
Name:FREIHEITER, JOHN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:FREIHEITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16 OLD BROOKSIDE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869
Mailing Address - Country:US
Mailing Address - Phone:973-895-8884
Mailing Address - Fax:973-895-2530
Practice Address - Street 1:16 OLD BROOKSIDE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869
Practice Address - Country:US
Practice Address - Phone:973-895-8884
Practice Address - Fax:973-895-2530
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA056783207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ545612ZAC5Medicare PIN
F91973Medicare UPIN