=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497058754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FELDMAN MEDICAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2010
-----------------------------------------------------
Last Update Date | 12/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1576 FLATBUSH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-557-5510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1576 FLATBUSH AVE
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-3030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-557-5510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | ERNESTO LOPEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-781-5075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 123637
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------