Provider Demographics
NPI:1790781904
Name:FELDMAN, SHLOMO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHLOMO
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 56TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-4737
Mailing Address - Country:US
Mailing Address - Phone:718-853-1892
Mailing Address - Fax:718-935-0426
Practice Address - Street 1:175 HEWES ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8057
Practice Address - Country:US
Practice Address - Phone:718-624-5456
Practice Address - Fax:718-935-0426
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0363151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00663218Medicaid