Provider Demographics
NPI:1316910219
Name:FELDER, KENNETH S (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:S
Last Name:FELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 RALPH AVE
Mailing Address - Street 2:SUITE A6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-209-0101
Mailing Address - Fax:718-209-0194
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:SUITE A6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:718-209-0101
Practice Address - Fax:718-209-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131057174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00717208Medicaid
NY00717208Medicaid
NY70A823Medicare PIN