Basic Information
| Provider Information | |||||||||
| NPI: | 1477623809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 WESTCHESTER AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149461010 | ||||||||
| FaxNumber: | 9149461025 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 WESTCHESTER AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149461010 | ||||||||
| FaxNumber: | 9149461025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 087622 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00306212 | 05 | NY | MEDICAID |