Healthcare Provider Details

I. General information

NPI: 1174029110
Provider Name (Legal Business Name): PHILLIP CHARLES FELICIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S OHIO AVE STE 2100
ATLANTIC CITY NJ
08401-6711
US

IV. Provider business mailing address

7 S OHIO AVE STE 2100
ATLANTIC CITY NJ
08401-6711
US

V. Phone/Fax

Practice location:
  • Phone: 609-572-8800
  • Fax:
Mailing address:
  • Phone: 609-572-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA13046600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA201537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: