Provider Demographics
NPI:1295843043
Name:FELSEN, JOSEPH THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:FELSEN
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 1:243 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895
Mailing Address - Country:US
Mailing Address - Phone:585-593-5555
Mailing Address - Fax:585-593-3827
Practice Address - Street 1:243 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895
Practice Address - Country:US
Practice Address - Phone:585-593-5555
Practice Address - Fax:585-593-3827
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60133852207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0021017901OtherUNIVERA
NY00554090Medicaid
0021017901OtherUNIVERA
078321Medicare ID - Type Unspecified