Provider Demographics
NPI:1265576565
Name:FRIEDMAN, PHILIP HYMAN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:HYMAN
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-5111
Mailing Address - Country:US
Mailing Address - Phone:718-852-3800
Mailing Address - Fax:718-852-3019
Practice Address - Street 1:156 SMITH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-8602
Practice Address - Country:US
Practice Address - Phone:718-852-3800
Practice Address - Fax:718-852-3019
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY100577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00172472Medicaid
NY00172472Medicaid
D47633Medicare UPIN