Healthcare Provider Details

I. General information

NPI: 1083924542
Provider Name (Legal Business Name): REBECCA F FELDMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 PENINSULA BLVD
WOODMERE NY
11598-1542
US

IV. Provider business mailing address

1090 PENINSULA BLVD
WOODMERE NY
11598-1542
US

V. Phone/Fax

Practice location:
  • Phone: 732-267-8720
  • Fax:
Mailing address:
  • Phone: 732-267-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number631586
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number341429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: