Provider Demographics
NPI:1336187434
Name:FRIDMAN, MOISEY (MD)
Entity type:Individual
Prefix:
First Name:MOISEY
Middle Name:
Last Name:FRIDMAN
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 1:9732 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1639
Mailing Address - Country:US
Mailing Address - Phone:718-275-2224
Mailing Address - Fax:718-275-9600
Practice Address - Street 1:9732 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1639
Practice Address - Country:US
Practice Address - Phone:718-275-2224
Practice Address - Fax:718-275-9600
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2282001207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06893GMedicare PIN
I01159Medicare UPIN