Provider Demographics
NPI:1528371135
Name:FELDMAN, GEORGENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGENE
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 ASCAN AVE
Mailing Address - Street 2:APT. 3E
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5370
Mailing Address - Country:US
Mailing Address - Phone:718-261-4909
Mailing Address - Fax:
Practice Address - Street 1:3555 223RD ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2236
Practice Address - Country:US
Practice Address - Phone:718-428-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1194016103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool