Provider Demographics
NPI:1124064159
Name:FREED, JEFFREY STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:STEPHEN
Last Name:FREED
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 1:969 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0322
Mailing Address - Country:US
Mailing Address - Phone:212-396-0050
Mailing Address - Fax:212-396-0050
Practice Address - Street 1:969 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0322
Practice Address - Country:US
Practice Address - Phone:212-396-0050
Practice Address - Fax:212-396-0050
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110976174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS655OtherOXFORD HEALTH PLANS
NYNS655OtherOXFORD HEALTH PLANS