Provider Demographics
NPI:1396964813
Name:FELDMAN, IGOR (PT)
Entity type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 65TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4088
Mailing Address - Country:US
Mailing Address - Phone:718-234-7848
Mailing Address - Fax:718-234-1703
Practice Address - Street 1:2310 65TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4088
Practice Address - Country:US
Practice Address - Phone:718-234-7848
Practice Address - Fax:718-234-1703
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017370225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQA415Q4CH1Medicare ID - Type Unspecified