Provider Demographics
NPI:1538498514
Name:FEDER, MICHAEL (CPED)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FEDER
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:FEDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPED
Mailing Address - Street 1:9941 64TH AVE
Mailing Address - Street 2:APT. C7
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2653
Mailing Address - Country:US
Mailing Address - Phone:718-440-5641
Mailing Address - Fax:
Practice Address - Street 1:3063 BRIGHTON 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5607
Practice Address - Country:US
Practice Address - Phone:718-554-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED2889225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter