MEDICARE: DR. LAWRENCE FEDER DDS

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	1223G0001X	General Practice Dentistry	029888	NY
2	1223G0001X	General Practice Dentistry	00983200	NJ

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	:	1568512267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE FEDER DDS

Provider Business Mailing Address
First Line	:	710 QUEEN ANNE RD
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-3316
Country	:	US
Telephone Number	:	201-692-1633
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. LAWRENCE FEDER DDS” Practice Location

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