1629071014 NPI number — DR. KIRA FELDMAN MD

Table of content: DR. KIRA FELDMAN MD (NPI 1629071014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629071014 NPI number — DR. KIRA FELDMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELDMAN
Provider First Name:
KIRA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1629071014
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
160 PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARNEGAT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08005-2061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-607-0210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
249 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BARNEGAT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08005-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-607-1010
Provider Business Practice Location Address Fax Number:
609-601-9992
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  MA070970 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MA070970 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23864 . This is a "AETNA/USHC HMO PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P2068029 . This is a "OXFORD PROVIDER ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5845148005 . This is a "CIGNA PROVIDER ID #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 2010619 . This is a "UNITED HEALTH CARE PROV #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60011030 . This is a "HORIZON NJ HEALTH PROV. #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 202119279100 . This is a "QUALCARE PROVIDER ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 89319 . This is a "AMERIGROUP PROVIDER ID #" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: K5402 . This is a "HORIZON BC/BS PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K5970 . This is a "HEALTHNET PROVIDER ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7755130 . This is a "AETNA/USHC PPO PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2354758001 . This is a "AMERIHEALTH PROVIDER ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8334200 . This is a "UNISYS NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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