Provider Demographics
NPI:1184378754
Name:FELDER, BENNETT
Entity type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:
Last Name:FELDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DOGWOOD HL
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-3205
Mailing Address - Country:US
Mailing Address - Phone:516-732-9892
Mailing Address - Fax:
Practice Address - Street 1:814 FULTON ST STE B
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3638
Practice Address - Country:US
Practice Address - Phone:516-420-1927
Practice Address - Fax:516-420-1952
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-11
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048511225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist