MEDICARE: DR. MICHAEL JOSEPH FEDAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	134691	NY
2	2084P0800X	Psychiatry Physician	134691	NY
3	2084P0802X	Addiction Psychiatry Physician	134691	NY

General Provider Information

NPI Number	:	1457603086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH FEDAK M.D.

Provider Business Mailing Address
First Line	:	655 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-5937
Country	:	US
Telephone Number	:	212-396-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-5937
Country	:	US
Telephone Number	:	212-396-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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