Basic Information
Provider Information
NPI: 1447465307
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FREEDMAN
FirstName: TERRY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 536
Address2:  
City: VOORHEES
State: NJ
PostalCode: 080430536
CountryCode: US
TelephoneNumber: 8566696050
FaxNumber: 8566510794
Practice Location
Address1: 150 CENTURY PKWY
Address2: SUITE A
City: MOUNT LAUREL
State: NJ
PostalCode: 080541129
CountryCode: US
TelephoneNumber: 8567781181
FaxNumber: 8567781572
Other Information
ProviderEnumerationDate: 05/14/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LX0001X26NN04242600NJY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology

No ID Information.


Home