Provider Demographics
NPI:1124102579
Name:FELDMAN, STUART (RPH)
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STALLION TRL
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4707
Mailing Address - Country:US
Mailing Address - Phone:845-278-6399
Mailing Address - Fax:914-763-6567
Practice Address - Street 1:20 NORTH SALEM ROAD
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518
Practice Address - Country:US
Practice Address - Phone:914-763-3152
Practice Address - Fax:914-763-6567
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3352933OtherNCPDP
NY01496006Medicaid
NY01496006Medicaid