Provider Demographics
NPI:1093835308
Name:FEIT, FREDRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDRIC
Middle Name:
Last Name:FEIT
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 1:2 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8680
Mailing Address - Country:US
Mailing Address - Phone:732-780-8648
Mailing Address - Fax:732-308-9983
Practice Address - Street 1:1474 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-3860
Practice Address - Country:US
Practice Address - Phone:718-618-0029
Practice Address - Fax:718-377-7474
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ561742081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY148172OtherLIC#
NJ11-281-2216OtherFEDERAL TAX ID#
NJ56174OtherLIC #
NJ56174OtherLIC #
NYFF1807760OtherDEA
NJFE685527Medicare PIN
NYFF1807760OtherDEA