Provider Demographics
NPI:1457420960
Name:FELDMAN, ROGER P (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:P
Last Name:FELDMAN
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 1:570 ELMONT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3535
Mailing Address - Country:US
Mailing Address - Phone:516-239-9138
Mailing Address - Fax:516-437-6050
Practice Address - Street 1:570 ELMONT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3535
Practice Address - Country:US
Practice Address - Phone:516-239-9138
Practice Address - Fax:516-437-6050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1345952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY134595Medicaid
NY18A65200Medicare ID - Type Unspecified
NY134595Medicaid