Healthcare Provider Details

I. General information

NPI: 1548247331
Provider Name (Legal Business Name): MARSHALL ROY FELDMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT GEORGES AVE
RAHWAY NJ
07065-2764
US

IV. Provider business mailing address

1600 SAINT GEORGES AVE
RAHWAY NJ
07065-2764
US

V. Phone/Fax

Practice location:
  • Phone: 732-388-2375
  • Fax: 732-388-2377
Mailing address:
  • Phone: 732-388-2375
  • Fax: 732-388-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00093400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: