Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 56174 | NJ |
NPI | 1093835308 |
---|---|
Provider Name | Dr. Fredric Feit |
First Address | Manalapan, NJ 07726-8680 |
Second Address | Brooklyn, NY 11230-3860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 04/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11-281-2216 | FEDERAL TAX ID# (01) | NJ |
148172 | LIC# (01) | NY |
56174 | LIC # (01) | NJ |
B19855 | (02) | NJ |
BF 3024065 | DEA # (01) | NJ |
FF1807760 | DEA (01) | NY |