Provider Demographics
NPI:1184647802
Name:FELDMAN, AILEEN (MD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2537
Mailing Address - Country:US
Mailing Address - Phone:860-628-9121
Mailing Address - Fax:860-276-8670
Practice Address - Street 1:51 N MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2537
Practice Address - Country:US
Practice Address - Phone:860-628-9121
Practice Address - Fax:860-276-8670
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1394622084P0800X
CT0261622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTA64907Medicare UPIN