Provider Demographics
NPI:1710457452
Name:FRIED, DANIEL M (PA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:FRIED
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14445 75TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2416
Mailing Address - Country:US
Mailing Address - Phone:718-619-0398
Mailing Address - Fax:
Practice Address - Street 1:7650 RIVER RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6527
Practice Address - Country:US
Practice Address - Phone:201-854-7390
Practice Address - Fax:201-453-2782
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00739300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical