Provider Demographics
NPI:1427294826
Name:FREED, PHILIP BRIAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:BRIAN
Last Name:FREED
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-7300
Mailing Address - Country:US
Mailing Address - Phone:908-823-4049
Mailing Address - Fax:908-534-6475
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:SAINT MICHAEL'S MEDICAL CENTER - DIV OF CARDIAC SURGERY
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-877-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00077100363A00000X
NY005611363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant