Provider Demographics
NPI:1871604462
Name:FEINSTEIN, MARVIN (OD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:FEINSTEIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11310 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2209
Mailing Address - Country:US
Mailing Address - Phone:718-474-1234
Mailing Address - Fax:718-945-5809
Practice Address - Street 1:11310 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2209
Practice Address - Country:US
Practice Address - Phone:718-474-1234
Practice Address - Fax:718-945-5809
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002941-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50988HMedicare PIN
NYG400000520Medicare PIN
NYT97463Medicare UPIN