MEDICARE: MRS. JESSICA FELDMAN

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1366085078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA FELDMAN

Provider Business Mailing Address
First Line	:	7 LIVINGSTON LN
Second Line	:
City	:	MANALAPAN
State	:	NJ
Zip	:	07726-2808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5808 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2111
Country	:	US
Telephone Number	:	646-228-6947
Fax Number	:

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

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/25/2019

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