Provider Demographics
NPI:1437306834
Name:MARVIN FELLER, MD,PC
Entity Type:Organization
Organization Name:MARVIN FELLER, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-843-4545
Mailing Address - Street 1:8510 151ST AVE
Mailing Address - Street 2:APT LL
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1302
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:APT LL
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1341
Practice Address - Country:US
Practice Address - Phone:718-843-4545
Practice Address - Fax:718-835-7271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082743-6174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY28110Medicare PIN