=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790055507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK R FELDMAN MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2012
-----------------------------------------------------
Last Update Date | 01/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 192 PINE ST
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-338-0599
-----------------------------------------------------
Fax | 845-338-4266
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 192 PINE ST
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-338-0599
-----------------------------------------------------
Fax | 845-338-4266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK R FELDMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 845-338-0599
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 127248
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------