Provider Demographics
NPI:1336787357
Name:DAN FELDMAN RD LLC
Entity Type:Organization
Organization Name:DAN FELDMAN RD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:516-376-3343
Mailing Address - Street 1:68 BARNES ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-2615
Mailing Address - Country:US
Mailing Address - Phone:516-376-3343
Mailing Address - Fax:
Practice Address - Street 1:68 BARNES ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2615
Practice Address - Country:US
Practice Address - Phone:516-376-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health