Provider Demographics
NPI:1780710749
Name:FELLER, PATRICIA ANN (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3671 HUDSON MANOR TER
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1137
Mailing Address - Country:US
Mailing Address - Phone:917-583-7167
Mailing Address - Fax:
Practice Address - Street 1:3671 HUDSON MANOR TER
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1137
Practice Address - Country:US
Practice Address - Phone:917-583-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121475207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08A182Medicare ID - Type UnspecifiedMEDICARE NUMBER
NYA98956Medicare UPIN