MEDICARE: MR. MICHAEL FEDER C.PED

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	225000000X	Orthotic Fitter	CPED2889	DE

General Provider Information

NPI Number	:	1538498514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL FEDER C.PED

Provider Business Mailing Address
First Line	:	9941 64TH AVE
Second Line	:	APT. C7
City	:	REGO PARK
State	:	NY
Zip	:	11374-2653
Country	:	US
Telephone Number	:	718-440-5641
Fax Number	:

Provider Business Practice Location Address
First Line	:	3063 BRIGHTON 13TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5607
Country	:	US
Telephone Number	:	718-554-3862
Fax Number	:

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

Provider Enumeration Date	:	12/21/2009
Last Update Date	:	12/21/2009

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