Provider Demographics
NPI:1912068008
Name:FIELDMAN, JOEL BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:BRUCE
Last Name:FIELDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 TURF LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2738
Mailing Address - Country:US
Mailing Address - Phone:718-416-4389
Mailing Address - Fax:718-416-3652
Practice Address - Street 1:40 TURF LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2738
Practice Address - Country:US
Practice Address - Phone:718-416-4389
Practice Address - Fax:718-416-3652
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193719207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01666320Medicaid
NY0154T1Medicare PIN
NY02424AMedicare PIN