Provider Demographics
NPI:1487743837
Name:HARRY A. FRIED M.D. LLC
Entity type:Organization
Organization Name:HARRY A. FRIED M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-594-0535
Mailing Address - Street 1:333 OLD HOOK RD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3200
Mailing Address - Country:US
Mailing Address - Phone:201-594-0535
Mailing Address - Fax:201-594-0538
Practice Address - Street 1:333 OLD HOOK RD
Practice Address - Street 2:SUITE # 101
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:201-594-0535
Practice Address - Fax:201-594-0538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060074207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ708225Medicare ID - Type Unspecified
NJF21034Medicare UPIN