MEDICARE: ROBERT M FEFERMAN

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	1041C0700X	Clinical Social Worker	72064967	NY

General Provider Information

NPI Number	:	1790724425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M FEFERMAN

Provider Business Mailing Address
First Line	:	170 W END AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-5401
Country	:	US
Telephone Number	:	212-595-1861
Fax Number	:

Provider Business Practice Location Address
First Line	:	6209 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2702
Country	:	US
Telephone Number	:	718-234-0073
Fax Number	:	718-236-8456

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	07/08/2007

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