Provider Demographics
NPI:1902864473
Name:FELD, GREGG (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:FELD
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:PO BOX 8000
Mailing Address - Street 2:DEPT 836
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-855-2866
Practice Address - Fax:716-855-2860
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19035912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00025344807OtherUNIVERA
000525472013OtherBLUE SHIELD OF WESTERN NY
161425463OtherEMPIRE PLAN
204329201OtherEMPIRE PLAN
743079229OtherEMPIRE PLAN
000525472010OtherBLUE SHIELD OF WESTERN NY
145800FFOtherPREFERRED CARE
0025344806OtherUNIVERA
NYW1903590WOtherWORKERS COMPENSATION
000525472011OtherBLUE SHIELD OF WESTERN NY
5605277OtherINDEPENDENT HEALTH
000525472006OtherBLUE SHIELD OF WESTERN NY
0025344805OtherUNIVERA
NY01357166Medicaid
161538169OtherEMPIRE PLAN
040426001304OtherFIDELIS
0025344805OtherUNIVERA
5605277OtherINDEPENDENT HEALTH
040426001304OtherFIDELIS
145800FFOtherPREFERRED CARE
NYCC3725Medicare PIN