Healthcare Provider Details

I. General information

NPI: 1558916239
Provider Name (Legal Business Name): LOLITA FELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E. RIDGEWOOD AVE SUITE 208
RIDGEWOOD NJ
07450
US

IV. Provider business mailing address

1200 E. RIDGEWOOD AVE SUITE 208
RIDGEWOOD NJ
07450
US

V. Phone/Fax

Practice location:
  • Phone: 201-444-0868
  • Fax: 201-493-0797
Mailing address:
  • Phone: 201-444-0868
  • Fax: 201-493-0797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA060848
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060848
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: