MEDICARE: JOEL BRUCE FIELDMAN MD P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	193719	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G100080710	OTHER	NY	MEDICARE PTAN
2	A100078038	OTHER	NY	MEDICARE PTAN
3	0154T1	OTHER	NY	MEDICARE PIN OTHER

General Provider Information

NPI Number	:	1174719769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOEL BRUCE FIELDMAN MD P.C.

Provider Business Mailing Address
First Line	:	40 TURF LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2738
Country	:	US
Telephone Number	:	718-416-4389
Fax Number	:	718-416-3652

Provider Business Practice Location Address
First Line	:	40 TURF LN
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-2738
Country	:	US
Telephone Number	:	718-416-4389
Fax Number	:	718-416-3652

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	MS. LETICIA COTTO
Credential	:
Telephone Number	:	718-416-4389

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	11/20/2013

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