Basic Information
| Provider Information | |||||||||
| NPI: | 1326048430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDLER | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 LOWELL AVE | ||||||||
| Address2: | |||||||||
| City: | NEW HYDE PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 110402810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163264160 | ||||||||
| FaxNumber: | 5164370482 | ||||||||
| Practice Location | |||||||||
| Address1: | 5847 188TH ST | ||||||||
| Address2: | |||||||||
| City: | FRESH MEADOWS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113652201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183578200 | ||||||||
| FaxNumber: | 7183575770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 10/10/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 211583-1 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 02293763 | 05 | NY | MEDICAID |