Provider Demographics
NPI:1316096126
Name:FEIGELIS, PAUL S (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:FEIGELIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6205
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-6205
Mailing Address - Country:US
Mailing Address - Phone:732-613-0317
Mailing Address - Fax:732-223-5472
Practice Address - Street 1:1407 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1119
Practice Address - Country:US
Practice Address - Phone:732-223-4242
Practice Address - Fax:732-223-5472
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA 00463600152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6542603Medicaid
NJFE 103675Medicare ID - Type Unspecified