Provider Demographics
NPI:1326028283
Name:FELLER, MARVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:FELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARVIN
Other - Middle Name:
Other - Last Name:FELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:8610 151ST AVE
Mailing Address - Street 2:MARVIN FELLER MD PC
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-843-4545
Mailing Address - Fax:718-835-7271
Practice Address - Street 1:8610 151ST AVE
Practice Address - Street 2:MARVIN FELLER MD PC
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-843-4545
Practice Address - Fax:718-835-7271
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082743207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0028110OtherGHI
156351OtherBLUE CROSS BLUE SHIELD
NY121935Medicaid
NY121935Medicaid
A60819Medicare UPIN