Provider Demographics
NPI:1093256091
Name:FEINSTEIN, MIRIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:FEINSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BLACK ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1200
Mailing Address - Country:US
Mailing Address - Phone:203-579-5000
Mailing Address - Fax:203-579-5359
Practice Address - Street 1:64 BLACK ROCK AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1200
Practice Address - Country:US
Practice Address - Phone:203-579-5000
Practice Address - Fax:203-579-5359
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant