Healthcare Provider Details

I. General information

NPI: 1558360081
Provider Name (Legal Business Name): JOHN MARTIN FEDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LINCOLN AVE
ROCKVILLE CENTRE NY
11570-5768
US

IV. Provider business mailing address

1728 SUNRISE HWY
MERRICK NY
11566-3745
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-2800
  • Fax:
Mailing address:
  • Phone: 516-992-4700
  • Fax: 516-992-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number177147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: