Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 231568 | NY |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 231568 | NY |
NPI | 1184674996 |
---|---|
Provider Name | Jodi Friedman |
First Address | Lagrangeville, NY 12540-5108 |
Second Address | Rhinebeck, NY 12572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02534265 | (05) | NY |
H62606 | (02) | NY |