Provider Demographics
NPI:1396921987
Name:RICHARD B. FELDMAN, D.P.M., LLC
Entity type:Organization
Organization Name:RICHARD B. FELDMAN, D.P.M., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-933-7477
Mailing Address - Street 1:655 SAW MILL RD
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-3964
Mailing Address - Country:US
Mailing Address - Phone:203-933-7477
Mailing Address - Fax:203-931-1775
Practice Address - Street 1:655 SAW MILL RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-3964
Practice Address - Country:US
Practice Address - Phone:203-933-7477
Practice Address - Fax:203-931-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X, 332B00000X
CT000242261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004047064Medicaid
CT004047064Medicaid
CT0517860001Medicare NSC