Provider Demographics
NPI:1336223858
Name:FEIGELMAN, GARY STUART
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:STUART
Last Name:FEIGELMAN
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 1:2926 JOYCE LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5207
Mailing Address - Country:US
Mailing Address - Phone:516-771-2166
Mailing Address - Fax:
Practice Address - Street 1:46 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1104
Practice Address - Country:US
Practice Address - Phone:516-791-5300
Practice Address - Fax:516-791-5391
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4632156FX1800X
NY004632-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0781060001Medicare NSC