Provider Demographics
NPI:1669673265
Name:KINGSWOOD MEDICAL
Entity Type:Organization
Organization Name:KINGSWOOD MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEIBUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-239-5959
Mailing Address - Street 1:290 CENTRAL AVE.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559
Mailing Address - Country:US
Mailing Address - Phone:516-239-5959
Mailing Address - Fax:516-239-6866
Practice Address - Street 1:290 CENTRAL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-8507
Practice Address - Country:US
Practice Address - Phone:516-239-5959
Practice Address - Fax:516-239-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124051207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty