Healthcare Provider Details

I. General information

NPI: 1871862938
Provider Name (Legal Business Name): ALAIN A. FEDIDA, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 68TH ST
NEW YORK NY
10065-6001
US

IV. Provider business mailing address

229 E 79TH ST # 2A
NEW YORK NY
10075-0866
US

V. Phone/Fax

Practice location:
  • Phone: 212-737-5599
  • Fax: 212-737-3624
Mailing address:
  • Phone: 877-895-0876
  • Fax: 631-206-9193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number172083
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number172083
License Number StateNY

VIII. Authorized Official

Name: DR. ALAIN A FEDIDA
Title or Position: OWNER / CFO
Credential: M.D.
Phone: 877-895-0876