Basic Information
| Provider Information | |||||||||
| NPI: | 1073773446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 CAMBRIDGE RD | ||||||||
| Address2: | |||||||||
| City: | EAST ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115182302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3163186558 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 OLD COUNTRY RD | ||||||||
| Address2: | SUITE 278 | ||||||||
| City: | MINEOLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115014235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168770977 | ||||||||
| FaxNumber: | 5162946861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2008 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 248456 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 248456 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 248456 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.