Provider Demographics
NPI:1821020264
Name:FEINGOLD, RANDALL SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:SCOTT
Last Name:FEINGOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 NORTHERN BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5322
Mailing Address - Country:US
Mailing Address - Phone:516-498-8400
Mailing Address - Fax:516-498-8404
Practice Address - Street 1:833 NORTHERN BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5322
Practice Address - Country:US
Practice Address - Phone:516-498-8400
Practice Address - Fax:516-498-8404
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176128208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79002Medicare UPIN
NY93N541Medicare ID - Type Unspecified