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General NPI Number Information
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NPI Number | 1417459876
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Entity Type | Individual
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Provider Name | MICHAEL FELDMAN PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 01/05/2024
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Provider Practice Location Address
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Address Line | 94 VALLEY RD FL 2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2211
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Country | US
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Telephone | 201-731-6244
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Fax |
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Provider Business Mailing Address
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Address Line | 553 S MAPLE AVE
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City | GLEN ROCK
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State | NJ
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Zip | 07452-1817
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Country | US
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Telephone | 609-903-1822
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MP00459100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00459100
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0211611
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 021611
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 25MP00459100
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License Number State | NJ
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