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General NPI Number Information
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NPI Number | 1174719769
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Entity Type | Organization
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Legal Business Name | JOEL BRUCE FIELDMAN MD P.C.
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | 40 TURF LN
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2738
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Country | US
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Telephone | 718-416-4389
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Fax | 718-416-3652
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Provider Business Mailing Address
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Address Line | 40 TURF LN
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City | ROSLYN HEIGHTS
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State | NY
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Zip | 11577-2738
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Country | US
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Telephone | 718-416-4389
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Fax | 718-416-3652
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MS. LETICIA COTTO
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Credential |
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Telephone | 718-416-4389
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 193719
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License Number State | NY
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