Basic Information
| Provider Information | |||||||||
| NPI: | 1841249497 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRIEDMAN | ||||||||
| FirstName: | JERROLD | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1272 | ||||||||
| Address2: | |||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080547272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567551616 | ||||||||
| FaxNumber: | 8567551616 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 E EVESHAM RD | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080439547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567511600 | ||||||||
| FaxNumber: | 8567511548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 01/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 25MA06914500 | NJ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | MD067120L | PA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0343567000 | 01 | NJ | AMERIHEALTH HMO | OTHER | 1155963 | 01 | NJ | HORIZON NJ HEALTH | OTHER | 568292 | 01 | PA BLUE SHIELD NJ PATIENT | OTHER | 30021071 | 01 | KEYSTONE MERCY | OTHER | 7961103 | 05 | NJ | MEDICAID | FR1648250 | 01 | HIGHMARK BCBS | OTHER | 250013591 | 01 | PA | RAILROAD MEDICARE | OTHER | 250013827 | 01 | NJ | RAILROAD MEDICARE | OTHER | 568292 | 01 | NJ | AMERIHEALTH PERSONAL CHOI | OTHER | NY212261 | 01 | EMPIRE BCBS | OTHER | 2672520 | 01 | NJ | AETNA HMO | OTHER | 5365751 | 01 | NJ | AETNA PPO | OTHER |