Provider Demographics
NPI:1013216472
Name:FELBAUM, DANIEL ROQUE (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROQUE
Last Name:FELBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CENTER BLVD. ACP, SUITE 232
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:844-464-6387
Mailing Address - Fax:215-239-3037
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BUILDING 3, SUITE D
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2300
Practice Address - Country:US
Practice Address - Phone:844-464-6387
Practice Address - Fax:215-539-3037
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460820207T00000X
NJ25MA10102100207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0580431Medicaid