Provider Demographics
NPI:1992958557
Name:FRIED, NORMAN JAY (PHD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:JAY
Last Name:FRIED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:NORMAN
Other - Middle Name:JAY
Other - Last Name:FRIED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:444 COMMUNITY DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3820
Mailing Address - Country:US
Mailing Address - Phone:516-891-6949
Mailing Address - Fax:
Practice Address - Street 1:444 COMMUNITY DR
Practice Address - Street 2:#304
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3820
Practice Address - Country:US
Practice Address - Phone:516-891-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011765-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist