Healthcare Provider Details

I. General information

NPI: 1396921987
Provider Name (Legal Business Name): RICHARD B. FELDMAN, D.P.M., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 SAW MILL RD
WEST HAVEN CT
06516-3964
US

IV. Provider business mailing address

655 SAW MILL RD
WEST HAVEN CT
06516-3964
US

V. Phone/Fax

Practice location:
  • Phone: 203-933-7477
  • Fax: 203-931-1775
Mailing address:
  • Phone: 203-933-7477
  • Fax: 203-931-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number000242
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD BARRY FELDMAN
Title or Position: PODIATRIST
Credential: D.P.M.
Phone: 203-933-7477