Provider Demographics
NPI:1871862938
Name:ALAIN A. FEDIDA, MD
Entity Type:Organization
Organization Name:ALAIN A. FEDIDA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FEDIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-895-0876
Mailing Address - Street 1:229 E 79TH ST # 2A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0866
Mailing Address - Country:US
Mailing Address - Phone:877-895-0876
Mailing Address - Fax:631-206-9193
Practice Address - Street 1:240 E 68TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6001
Practice Address - Country:US
Practice Address - Phone:212-737-5599
Practice Address - Fax:212-737-3624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172083207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY93H793OtherMEDICARE ID-TYPE UNSPECIFIED
NY01129006Medicaid
NYF43401Medicare UPIN