Provider Demographics
NPI:1912276452
Name:NEW WAVE THERAPY INC
Entity type:Organization
Organization Name:NEW WAVE THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIDMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:818-428-8357
Mailing Address - Street 1:4073 CAMELLIA AVE
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3007
Mailing Address - Country:US
Mailing Address - Phone:818-428-8357
Mailing Address - Fax:818-753-9600
Practice Address - Street 1:4073 CAMELLIA AVE
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-3007
Practice Address - Country:US
Practice Address - Phone:818-428-8357
Practice Address - Fax:818-753-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service