Provider Demographics
NPI:1861599037
Name:MICHAEL E FRESHMAN,MD,PC
Entity type:Organization
Organization Name:MICHAEL E FRESHMAN,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FRESHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-274-5551
Mailing Address - Street 1:1444 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1600
Mailing Address - Country:US
Mailing Address - Phone:518-274-5551
Mailing Address - Fax:518-274-2060
Practice Address - Street 1:1444 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1600
Practice Address - Country:US
Practice Address - Phone:518-274-5551
Practice Address - Fax:518-274-2060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239161207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY181002396OtherRAILROAD MEDICARE
NY0721600001Medicare NSC
NYBA0858Medicare ID - Type Unspecified