Provider Demographics
NPI:1457304552
Name:FELDMAN, IAN (MSPT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 SHEEPSHEAD BAY RD
Mailing Address - Street 2:STE 430
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3605
Mailing Address - Country:US
Mailing Address - Phone:516-385-2492
Mailing Address - Fax:516-385-2492
Practice Address - Street 1:69 GARDEN CITY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1930
Practice Address - Country:US
Practice Address - Phone:516-385-2492
Practice Address - Fax:516-385-2492
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ26P11Medicare PIN