Basic Information
| Provider Information | |||||||||
| NPI: | 1801251814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRIENDLY MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207 HALLOCK ROAD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316896226 | ||||||||
| FaxNumber: | 6316750736 | ||||||||
| Practice Location | |||||||||
| Address1: | 207 HALLOCK ROAD | ||||||||
| Address2: | |||||||||
| City: | STONY BROOK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316896226 | ||||||||
| FaxNumber: | 6316750736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2015 | ||||||||
| LastUpdateDate: | 12/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | TEDESCO | ||||||||
| AuthorizedOfficialFirstName: | ROSANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6316896226 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 462504 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 154768 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 60275504 | NY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 248234 | NY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.