Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 177147 | NY |
NPI | 1558360081 |
---|---|
Provider Name | John Martin Feder |
First Address | Merrick, NY 11566-3745 |
Second Address | Rockville Centre, NY 11570-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 23/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F20402 | (02) | NY |