Healthcare Provider Details

I. General information

NPI: 1033151006
Provider Name (Legal Business Name): ROBERT D FELDMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MAPLE AVE
RED BANK NJ
07701-1727
US

IV. Provider business mailing address

227 MAPLE AVE
RED BANK NJ
07701-1727
US

V. Phone/Fax

Practice location:
  • Phone: 732-842-6990
  • Fax: 732-842-6996
Mailing address:
  • Phone: 732-842-6990
  • Fax: 732-842-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberNJ10344
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: