=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265601090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAL D. FELDMAN, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2008
-----------------------------------------------------
Last Update Date | 12/19/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 WALT WHITMAN RD SUITE 104
-----------------------------------------------------
City | HUNTINGTON STATION
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-3640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-423-2642
-----------------------------------------------------
Fax | 631-423-1364
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 719
-----------------------------------------------------
City | MERRICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11566-0719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-423-2642
-----------------------------------------------------
Fax | 631-423-1364
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | HAL D. FELDMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 631-423-2642
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 206042
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------