Healthcare Provider Details

I. General information

NPI: 1619339199
Provider Name (Legal Business Name): LANCE MATTHEW FELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

1991 MARCUS AVE STE 302
NEW HYDE PARK NY
11042-2058
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number297382-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: