Healthcare Provider Details

I. General information

NPI: 1083546063
Provider Name (Legal Business Name): KEVIN FELDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PINEWOOD AVE
WEST LONG BRANCH NJ
07764-1871
US

IV. Provider business mailing address

273 16TH ST APT 810
JERSEY CITY NJ
07310-1061
US

V. Phone/Fax

Practice location:
  • Phone: 305-586-9741
  • Fax:
Mailing address:
  • Phone: 305-586-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: