Healthcare Provider Details

I. General information

NPI: 1316043201
Provider Name (Legal Business Name): FELICIANO EMRALINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE 4TH FLOOR, MILLS BLDG
BRONX NY
10457-2545
US

IV. Provider business mailing address

254 RIDGE RD
NUTLEY NJ
07110-2102
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-9331
  • Fax: 718-960-3792
Mailing address:
  • Phone: 973-661-2484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number189687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: