Provider Demographics
NPI:1295843456
Name:FELDMAN, GARY B (DPM)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:260 W SUNRISE HWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1015
Mailing Address - Country:US
Mailing Address - Phone:516-825-6825
Mailing Address - Fax:516-791-0174
Practice Address - Street 1:260 W SUNRISE HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1015
Practice Address - Country:US
Practice Address - Phone:516-825-6825
Practice Address - Fax:516-791-0174
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN004084213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT11279Medicare UPIN
NY1000980002Medicare NSC