Healthcare Provider Details

I. General information

NPI: 1730257023
Provider Name (Legal Business Name): JOSEPH G. FEGHALI, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 E 210TH ST
BRONX NY
10467-2411
US

IV. Provider business mailing address

182 E 210TH ST
BRONX NY
10467-2411
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-3277
  • Fax: 718-881-4911
Mailing address:
  • Phone: 718-881-3277
  • Fax: 718-881-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number141640
License Number StateNY

VIII. Authorized Official

Name: DR. JOSEPH G. FEGHALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-881-3277