Healthcare Provider Details

I. General information

NPI: 1063559904
Provider Name (Legal Business Name): MICHAEL FELDSTEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 MAIDEN LANE 6TH FLOOR
NEW YORK NY
10038-4812
US

IV. Provider business mailing address

83 MAIDEN LANE 6TH FLOOR
NEW YORK NY
10038-4812
US

V. Phone/Fax

Practice location:
  • Phone: 212-895-3410
  • Fax: 212-420-7211
Mailing address:
  • Phone: 212-895-3410
  • Fax: 212-420-7211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number049213-0
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: