MEDICARE: DR. NECHAMA TAMAR FERTIG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	053648	NY

General Provider Information

NPI Number	:	1417119397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NECHAMA TAMAR FERTIG DDS

Provider Business Mailing Address
First Line	:	875 W END AVE
Second Line	:	APT 12 B
City	:	NEW YORK
State	:	NY
Zip	:	10025-4919
Country	:	US
Telephone Number	:	212-222-0514
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 AVENUE P
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1448
Country	:	US
Telephone Number	:	718-339-8400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2008
Last Update Date	:	07/01/2008

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