Provider Demographics
NPI:1336163070
Name:FEDIDA, ALAIN ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:ALAIN
Middle Name:ALBERT
Last Name:FEDIDA
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 1:229 E 79TH ST
Mailing Address - Street 2:#2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0866
Mailing Address - Country:US
Mailing Address - Phone:917-609-3912
Mailing Address - Fax:
Practice Address - Street 1:1000 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0934
Practice Address - Country:US
Practice Address - Phone:917-609-3912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172083207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01129006Medicaid
NYA3000063413Medicare Oscar/Certification
NY01129006Medicaid