=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275684458
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METRO HEALTH MEDICAL P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79-18 164TH STREET
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-380-6002
-----------------------------------------------------
Fax | 718-380-6148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79-18 164TH STREET
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-1115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-380-6002
-----------------------------------------------------
Fax | 718-380-6148
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID M. FELDMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 718-380-6002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 179239-3
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------