Provider Demographics
NPI:1194070714
Name:BRUCE L FELDMAN, MD, PLLC
Entity type:Organization
Organization Name:BRUCE L FELDMAN, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-588-8500
Mailing Address - Street 1:44 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1913
Mailing Address - Country:US
Mailing Address - Phone:516-588-8500
Mailing Address - Fax:888-425-9273
Practice Address - Street 1:755 NEW YORK AVE STE 308
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:516-588-8500
Practice Address - Fax:888-425-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-19
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty