MEDICARE: DR. WAYNE MARC FELDMAN D.P.M.

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	213EP1101X	Primary Podiatric Medicine Podiatrist	25MD00247100	NJ
2	213EP1101X	Primary Podiatric Medicine Podiatrist	N003078-1	NY

General Provider Information

NPI Number	:	1821097809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE MARC FELDMAN D.P.M.

Provider Business Mailing Address
First Line	:	4511 LITTLE NECK PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-1426
Country	:	US
Telephone Number	:	718-229-1461
Fax Number	:	718-631-9176

Provider Business Practice Location Address
First Line	:	4511 LITTLE NECK PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-1426
Country	:	US
Telephone Number	:	718-229-1461
Fax Number	:	718-631-9176

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/08/2007

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