Provider Demographics
NPI:1285697771
Name:FRIEDMAN, HENRY DAN (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:DAN
Last Name:FRIEDMAN
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 1:105 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3603
Mailing Address - Country:US
Mailing Address - Phone:315-478-8425
Mailing Address - Fax:315-478-8425
Practice Address - Street 1:VAMC/LAB113/C369
Practice Address - Street 2:800 IRVING AVENUE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-425-4802
Practice Address - Fax:315-425-4805
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17155-1207ZC0500X
NY177155-1207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54553FMedicare ID - Type UnspecifiedMEDICARE#