Provider Demographics
NPI:1124012687
Name:FELDMAN, MARTIN (DDS)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W 95TH ST
Mailing Address - Street 2:17F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6331
Mailing Address - Country:US
Mailing Address - Phone:212-678-2662
Mailing Address - Fax:212-678-2662
Practice Address - Street 1:453 MOTHER GASTON BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-7617
Practice Address - Country:US
Practice Address - Phone:718-342-3266
Practice Address - Fax:719-342-3298
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0198951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019895OtherLICENSE
NY00282673Medicaid