Healthcare Provider Details

I. General information

NPI: 1376256545
Provider Name (Legal Business Name): MIRIAM YEHUDIS FELDHEIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 ROUTE 59
MONSEY NY
10952
US

IV. Provider business mailing address

58 ROUTE 59
MONSEY NY
10952
US

V. Phone/Fax

Practice location:
  • Phone: 845-503-0296
  • Fax:
Mailing address:
  • Phone: 845-503-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: