Healthcare Provider Details

I. General information

NPI: 1467453050
Provider Name (Legal Business Name): SAMANTHA BETH FEDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/21/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 WEST 80TH ST
NEW YORK NY
10024
US

IV. Provider business mailing address

232 WEST 80TH ST
NEW YORK NY
10024
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-3020
  • Fax:
Mailing address:
  • Phone: 646-962-3020
  • Fax: 516-333-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number217287-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: