Healthcare Provider Details

I. General information

NPI: 1285572420
Provider Name (Legal Business Name): COULSTON FELDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W SHERMAN AVE
VINELAND NJ
08360-7059
US

IV. Provider business mailing address

25 VARDON WAY
FARMINGDALE NJ
07727-3955
US

V. Phone/Fax

Practice location:
  • Phone: 856-641-8000
  • Fax:
Mailing address:
  • Phone: 732-997-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: