Provider Demographics
NPI:1548269558
Name:FRIEDMAN, MARK T (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:281 SYOSSET WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1205
Mailing Address - Country:US
Mailing Address - Phone:212-523-7242
Mailing Address - Fax:212-523-6394
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-4332
Practice Address - Fax:212-523-4829
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY186947207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF49054Medicare UPIN
NY38H301Medicare ID - Type Unspecified