Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 059957 | NY |
Y | 213EG0000X | General Practice | 059957 | NY |
NPI | 1003341330 |
---|---|
Provider Name | Haim Fedida |
First Address | New York, NY 10035-1759 |
Second Address | New York, NY 10035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 30/08/2018 |