Healthcare Provider Details

I. General information

NPI: 1356346779
Provider Name (Legal Business Name): DAVID ALLEN FEINGOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 COTTAGE GROVE RD STE F120
BLOOMFIELD CT
06002-3095
US

IV. Provider business mailing address

35 JOLLEY DR STE 101
BLOOMFIELD CT
06002-4228
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-3434
  • Fax: 860-243-0208
Mailing address:
  • Phone: 860-243-3434
  • Fax: 860-243-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number035179
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001351791
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier010035179CT03
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBCBS
# 3
Identifier0187241
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerMASS. HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: