Basic Information
| Provider Information | |||||||||
| NPI: | 1295709004 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELDMAN | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 508 BLAKE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065151287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033970624 | ||||||||
| FaxNumber: | 2033970372 | ||||||||
| Practice Location | |||||||||
| Address1: | 2499 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 066155843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033770003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | P00339 | CT | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 004057402 | 05 | CT | MEDICAID |