MEDICARE: NEW YORK FERTILITY PLLC

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	174400000X	Specialist	212419	NY

General Provider Information

NPI Number	:	1861432395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YORK FERTILITY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 750039
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-0039
Country	:	US
Telephone Number	:	718-793-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	108-48 70TH RD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3961
Country	:	US
Telephone Number	:	718-793-7752
Fax Number	:

Authorized Official
Title or Position	:	BILLING/CREDENTIALING MGR.
Name	:	MR. VINCENT FERGUSON
Credential	:
Telephone Number	:	813-938-5693

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/30/2022

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