Provider Demographics
NPI:1326119421
Name:FEILHARDT, SEYMOUR S (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEYMOUR
Middle Name:S
Last Name:FEILHARDT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2292 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5610
Mailing Address - Country:US
Mailing Address - Phone:718-241-7070
Mailing Address - Fax:718-241-7073
Practice Address - Street 1:2292 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5610
Practice Address - Country:US
Practice Address - Phone:718-241-7070
Practice Address - Fax:718-241-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0368361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02194356Medicaid