Healthcare Provider Details

I. General information

NPI: 1447331087
Provider Name (Legal Business Name): JONATHAN AMIR FEISTMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 9TH ST
NEW YORK NY
10003-5944
US

IV. Provider business mailing address

20 E 9TH ST
NEW YORK NY
10003-5944
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-0999
  • Fax: 212-202-4884
Mailing address:
  • Phone: 212-203-0999
  • Fax: 212-202-4884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number240088
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number7604451-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME93051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: