Basic Information
| Provider Information | |||||||||
| NPI: | 1093256091 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEINSTEIN | ||||||||
| FirstName: | MIRIAM | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64 BLACK ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066051200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035795000 | ||||||||
| FaxNumber: | 2035795359 | ||||||||
| Practice Location | |||||||||
| Address1: | 64 BLACK ROCK AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066051200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035795000 | ||||||||
| FaxNumber: | 2035795359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2017 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 3780 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.