Provider Demographics
NPI:1871068627
Name:FRIEDMAN, MIREL FRAYDY
Entity type:Individual
Prefix:
First Name:MIREL
Middle Name:FRAYDY
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CRYSTAL MILE CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1464
Mailing Address - Country:US
Mailing Address - Phone:917-613-3256
Mailing Address - Fax:
Practice Address - Street 1:1200 RIVER AVE STE 10C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5657
Practice Address - Country:US
Practice Address - Phone:917-613-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01816500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist