Basic Information
| Provider Information | |||||||||
| NPI: | 1801297775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEILER | ||||||||
| FirstName: | MARY | ||||||||
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| Credential: | PNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 W MAIN ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | SAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117822540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315638190 | ||||||||
| FaxNumber: | 6315638194 | ||||||||
| Practice Location | |||||||||
| Address1: | 285 W MAIN ST STE 104 | ||||||||
| Address2: | |||||||||
| City: | SAYVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117822540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315638190 | ||||||||
| FaxNumber: | 6315638194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2014 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 382476 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 363LP0200X | 382476-1N | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.