Provider Demographics
NPI:1194763763
Name:FELDMAN MEDICAL PC
Entity type:Organization
Organization Name:FELDMAN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-781-5075
Mailing Address - Street 1:4290 BROADWAY
Mailing Address - Street 2:SUITE 2-S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3732
Mailing Address - Country:US
Mailing Address - Phone:212-781-5075
Mailing Address - Fax:
Practice Address - Street 1:4290 BROADWAY
Practice Address - Street 2:SUITE 2-S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3732
Practice Address - Country:US
Practice Address - Phone:212-781-5075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103155-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02531928Medicaid
NYWEQ562Medicare PIN