Provider Demographics
NPI:1306161690
Name:FRIEDBERG, MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:FRIEDBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W MANTUA AVE
Mailing Address - Street 2:1A
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1805
Mailing Address - Country:US
Mailing Address - Phone:856-292-3360
Mailing Address - Fax:856-292-3574
Practice Address - Street 1:2 W MANTUA AVE
Practice Address - Street 2:1A
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1805
Practice Address - Country:US
Practice Address - Phone:856-292-3360
Practice Address - Fax:856-292-3574
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00672400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor