Individual
KENNETH FREESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2201 HEMPSTEAD TPKE, MEDICAL STAFF BOX # 42, EAST MEADOW, NY 11554-1859
(516) 572-6803
(516) 572-5019
Mailing address
2201 HEMPSTEAD TPKE, EAST MEADOW, NY 11554-1859
(516) 572-6803
(516) 572-5019
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
112407
NY
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
112407
NY
207R00000X
Internal Medicine Physician
112407
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00771682
—
NY
Enumeration date
03/09/2006
Last updated
04/10/2008
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