Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 246489 | NY |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD443215 | PA |
NPI | 1114173424 |
---|---|
Provider Name | Dr. Jason L Freedman |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 14/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
246489 | NYS LICENSE NUMBER (01) | NY |
443215 | STATE LICENSING BOARD - PENNSYLVANIA (01) | PA |