1508099870 NPI number — MARINA J. FEYGIN MEDICAL P.C.

Table of content: (NPI 1508099870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508099870 NPI number — MARINA J. FEYGIN MEDICAL P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINA J. FEYGIN MEDICAL P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508099870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2815 OCEAN PKWY
Provider Second Line Business Mailing Address:
SUITE L1
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-7839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-891-3005
Provider Business Mailing Address Fax Number:
781-891-3007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2815 OCEAN PKWY
Provider Second Line Business Practice Location Address:
SUITE L1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-7839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-891-3005
Provider Business Practice Location Address Fax Number:
781-891-3007
Provider Enumeration Date:
09/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FEYGIN
Authorized Official First Name:
MARINA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PSYCHIATRY
Authorized Official Telephone Number:
917-597-2206

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  216924 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02081074 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2129711 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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