Provider Demographics
NPI:1720352628
Name:FELDMAN, RENATA
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 QUENTIN RD APT 4H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1434
Mailing Address - Country:US
Mailing Address - Phone:718-578-9525
Mailing Address - Fax:
Practice Address - Street 1:2495 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7427
Practice Address - Country:US
Practice Address - Phone:212-787-2194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI056088-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist