Provider Demographics
NPI:1538398029
Name:FRIEDMAN, BRUCE GARY (RN)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:GARY
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5520
Mailing Address - Country:US
Mailing Address - Phone:845-342-2824
Mailing Address - Fax:
Practice Address - Street 1:61 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5520
Practice Address - Country:US
Practice Address - Phone:845-342-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY574938-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse