Basic Information
| Provider Information | |||||||||
| NPI: | 1366492126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRETZ FRIEDMAN | ||||||||
| FirstName: | ELISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 E 98TH ST | ||||||||
| Address2: | 2ND FLOOR BOX 1174 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122417952 | ||||||||
| FaxNumber: | 2122411238 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 E 98TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122417952 | ||||||||
| FaxNumber: | 2122411238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 164472 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3373811 | 01 | NY | AETNA HMO | OTHER | 02312398 | 05 | NY | MEDICAID | 7176533 | 01 | NY | AETNA PPO | OTHER | P3060599 | 01 | NY | OXFORD/FREEDOM/MEDICARE | OTHER | 1534753 | 01 | NY | UHC/HMO/POS/PPO/EPO/INDEM | OTHER | 52Z721 | 01 | NY | EMPIRE HMOPPO/POS/INDEMN | OTHER | 1443044 | 01 | NY | CIGNA/PPO/POS/HMO/INDEMN | OTHER |