Healthcare Provider Details

I. General information

NPI: 1013488972
Provider Name (Legal Business Name): INSTAR MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GEORGETOWN PL
SMITHTOWN NY
11787-4912
US

IV. Provider business mailing address

14 GEORGETOWN PL
SMITHTOWN NY
11787-4912
US

V. Phone/Fax

Practice location:
  • Phone: 631-793-8267
  • Fax: 631-793-8267
Mailing address:
  • Phone: 631-793-8267
  • Fax: 516-825-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC JAMES FELDMANN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 631-793-8267