Healthcare Provider Details

I. General information

NPI: 1174719769
Provider Name (Legal Business Name): JOEL BRUCE FIELDMAN MD P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TURF LN
ROSLYN HEIGHTS NY
11577-2738
US

IV. Provider business mailing address

40 TURF LN
ROSLYN HEIGHTS NY
11577-2738
US

V. Phone/Fax

Practice location:
  • Phone: 718-416-4389
  • Fax: 718-416-3652
Mailing address:
  • Phone: 718-416-4389
  • Fax: 718-416-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number193719
License Number StateNY

VIII. Authorized Official

Name: MS. LETICIA COTTO
Title or Position: ADMINSTRATOR
Credential:
Phone: 718-416-4389