Provider Demographics
NPI:1194167502
Name:FRIED, MICHELLE SOLOVE (ACNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SOLOVE
Last Name:FRIED
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 CLARKSON AVENUE
Mailing Address - Street 2:5TH FLOOR, NS51
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203
Mailing Address - Country:US
Mailing Address - Phone:718-270-1980
Mailing Address - Fax:718-270-2527
Practice Address - Street 1:470 CLARKSON AVENUE
Practice Address - Street 2:5TH FLOOR, NS51
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203
Practice Address - Country:US
Practice Address - Phone:718-270-1980
Practice Address - Fax:718-270-2527
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430643-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care