MEDICARE: DR LAWRENCE FEDER

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	122300000X	Dentist	029888	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	:	1528306370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR LAWRENCE FEDER

Provider Business Mailing Address
First Line	:	55 AVENUE C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-6855
Country	:	US
Telephone Number	:	212-673-3698
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 AVENUE C
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10009-6855
Country	:	US
Telephone Number	:	212-673-3698
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE FEDER
Credential	:	DDS
Telephone Number	:	212-673-3698

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	03/16/2015

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Directions to “DR LAWRENCE FEDER ” Practice Location

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