Provider Demographics
NPI:1962717678
Name:JENNIFER FRIEDMAN OD PC
Entity type:Organization
Organization Name:JENNIFER FRIEDMAN OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-729-5300
Mailing Address - Street 1:75 WALL ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005-2833
Mailing Address - Country:US
Mailing Address - Phone:212-729-5300
Mailing Address - Fax:212-729-5382
Practice Address - Street 1:7 BACKUS AVE
Practice Address - Street 2:DANBURY FAIR MALL
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7422
Practice Address - Country:US
Practice Address - Phone:203-790-1341
Practice Address - Fax:203-790-5052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03225638Medicaid