Provider Demographics
NPI:1497132039
Name:SAMUEL FELDMAN PH.D
Entity Type:Organization
Organization Name:SAMUEL FELDMAN PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-894-9222
Mailing Address - Street 1:2110 NE 206TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-2229
Mailing Address - Country:US
Mailing Address - Phone:195-489-4922
Mailing Address - Fax:954-432-8205
Practice Address - Street 1:2110 NE 206TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2229
Practice Address - Country:US
Practice Address - Phone:195-489-4922
Practice Address - Fax:954-432-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2190103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty