=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366596835
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA O FELS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 EAST 79TH ST SUITE 51
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-879-1499
-----------------------------------------------------
Fax | 212-717-5682
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 EAST 79TH ST SUITE 51
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-879-1499
-----------------------------------------------------
Fax | 212-717-5682
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 138466
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------