Healthcare Provider Details

I. General information

NPI: 1043193501
Provider Name (Legal Business Name): AVITAL P FELDSTEIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2025
Last Update Date: 07/30/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SHEFFIELD AVE
BROOKLYN NY
11207-2420
US

IV. Provider business mailing address

7038 136TH ST
FLUSHING NY
11367-1947
US

V. Phone/Fax

Practice location:
  • Phone: 718-345-2273
  • Fax:
Mailing address:
  • Phone: 347-803-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: