Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 25MA06682400 | NJ |
N | 208800000X | Urologist | 25MA06682466824 | NJ |
NPI | 1033195391 |
---|---|
Provider Name | Dr. Russell M Freid |
First Address | Lawrenceville, NJ 08648-2320 |
Second Address | Lawrenceville, NJ 08648-2320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 06/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7636504 | (05) | NJ |