Provider Demographics
NPI:1699066316
Name:FELDBERG, MARINA (MS SLP CCC)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:FELDBERG
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:VLASIUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SLP CCC
Mailing Address - Street 1:202 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4514
Mailing Address - Country:US
Mailing Address - Phone:718-438-4010
Mailing Address - Fax:
Practice Address - Street 1:202 AVENUE C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4514
Practice Address - Country:US
Practice Address - Phone:718-438-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020267-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist