Provider Demographics
NPI:1528355781
Name:FRIEND, KRISTOFFER JACOB (MS, ATC/L)
Entity type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:JACOB
Last Name:FRIEND
Suffix:
Gender:M
Credentials:MS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 STILLWATER RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1726
Mailing Address - Country:US
Mailing Address - Phone:203-886-8841
Mailing Address - Fax:
Practice Address - Street 1:761 STILLWATER RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1726
Practice Address - Country:US
Practice Address - Phone:203-886-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer