Provider Demographics
NPI:1396871778
Name:FELDMAN, SUSAN M
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1882 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2027
Mailing Address - Country:US
Mailing Address - Phone:718-621-2112
Mailing Address - Fax:
Practice Address - Street 1:5014 16TH AVE
Practice Address - Street 2:STE 342
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-1404
Practice Address - Country:US
Practice Address - Phone:347-967-8055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX001984111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX12211Medicare ID - Type Unspecified
NYT51956Medicare UPIN