Provider Demographics
NPI:1053004960
Name:FELDMAN, SUSAN (PT, PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-0463
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 INDIAN PIPE DR
Practice Address - Street 2:
Practice Address - City:QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11959-4240
Practice Address - Country:US
Practice Address - Phone:917-498-0030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist