Provider Demographics
NPI:1790055507
Name:MARK R FELDMAN MD PC
Entity Type:Organization
Organization Name:MARK R FELDMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-338-0599
Mailing Address - Street 1:192 PINE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4528
Mailing Address - Country:US
Mailing Address - Phone:845-338-0599
Mailing Address - Fax:845-338-4266
Practice Address - Street 1:192 PINE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4528
Practice Address - Country:US
Practice Address - Phone:845-338-0599
Practice Address - Fax:845-338-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127248174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00470860Medicaid
NY294981OtherMEDICARE ID-TYPE UNSPECIFIED
NYA300001588OtherMEDICARE PTAN
NY294981OtherMEDICARE ID-TYPE UNSPECIFIED
NYC07968Medicare UPIN