Provider Demographics
NPI:1730550476
Name:FELLER, ALAN (DO)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:FELLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:287 NORTHERN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4700
Mailing Address - Country:US
Mailing Address - Phone:516-487-3797
Mailing Address - Fax:516-466-8356
Practice Address - Street 1:287 NORTHERN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4700
Practice Address - Country:US
Practice Address - Phone:516-487-3797
Practice Address - Fax:516-466-8356
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY198325208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice