MEDICARE: DR. KENNETH S FELDER M.D.

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	174400000X	Specialist	131057	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316910219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH S FELDER M.D.

Provider Business Mailing Address
First Line	:	2035 RALPH AVE
Second Line	:	SUITE A6
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-209-0101
Fax Number	:	718-209-0194

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE
Second Line	:	SUITE A6
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-209-0101
Fax Number	:	718-209-0194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	01/27/2010

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