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General NPI Number Information
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NPI Number | 1376515833
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Entity Type | Individual
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Provider Name | MARC JEFFREY FEDERBUSCH D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 10/27/2007
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Provider Practice Location Address
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Address Line | 6534 MYRTLE AVE
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City | GLENDALE
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State | NY
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Zip | 11385-6212
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Country | US
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Telephone | 718-366-3338
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Fax | 718-366-2633
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Provider Business Mailing Address
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Address Line | 13 SHELLY CT
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City | PLAINVIEW
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State | NY
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Zip | 11803-5309
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Country | US
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Telephone | 516-822-3649
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Fax | 516-681-3411
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N003554
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License Number State | NY
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