Basic Information
| Provider Information | |||||||||
| NPI: | 1033170931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | SETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BROOKDALE PLAZA | ||||||||
| Address2: | PHYSICIAN ENTERPRISE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112123139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182407143 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE BROOKDALE PLAZA | ||||||||
| Address2: | OBH PHYSICIAN ENTERPRISE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112121121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182405622 | ||||||||
| FaxNumber: | 7182405808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2006 | ||||||||
| LastUpdateDate: | 05/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 15793 | AL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 17079 | OK | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 104975 | MO | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 18862 | WV | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 144674 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208100000X | 144674 | NY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 15793 | AL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 17079 | OK | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 104975 | MO | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 18862 | WV | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0551089 | 01 | CIGNA | OTHER | GF52693861 | 01 | APP ONE | OTHER | 000000077372 | 01 | GHI | OTHER | 5850533 | 01 | AETNA OUT OF NETWORK | OTHER |