Provider Demographics
NPI:1760653000
Name:FELDSTEIN, MICHAEL STUART (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STUART
Last Name:FELDSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 JEWEL AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1722
Mailing Address - Country:US
Mailing Address - Phone:718-463-5268
Mailing Address - Fax:718-463-2308
Practice Address - Street 1:14401 JEWEL AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1722
Practice Address - Country:US
Practice Address - Phone:718-261-7071
Practice Address - Fax:718-261-7071
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01693250Medicaid