MEDICARE: GABRIEL 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	2083P0901X	Public Health & General Preventive Medicine Physician	171312	NY

General Provider Information

NPI Number	:	1619356979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL FELDMAN

Provider Business Mailing Address
First Line	:	205 W 88TH ST
Second Line	:	7G
City	:	NEW YORK
State	:	NY
Zip	:	10024-2351
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W 88TH ST
Second Line	:	7G
City	:	NEW YORK
State	:	NY
Zip	:	10024-2351
Country	:	US
Telephone Number	:	646-256-2381
Fax Number	:

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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