Provider Demographics
NPI:1083635775
Name:FELDMAN, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:FELDMAN
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 1:218 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4107
Mailing Address - Country:US
Mailing Address - Phone:845-986-7830
Mailing Address - Fax:
Practice Address - Street 1:218 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4107
Practice Address - Country:US
Practice Address - Phone:845-986-7830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198381208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G28669Medicare UPIN
NY405I31Medicare ID - Type Unspecified