Healthcare Provider Details

I. General information

NPI: 1770102311
Provider Name (Legal Business Name): ANDREW MARC FELDMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE RM Y.217
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

1305 YORK AVE RM Y.217
NEW YORK NY
10021-5663
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-9776
  • Fax: 646-962-0511
Mailing address:
  • Phone: 646-962-9776
  • Fax: 646-962-0511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number329872
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: