Healthcare Provider Details

I. General information

NPI: 1740253483
Provider Name (Legal Business Name): FERNANDO FERRER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SIMSBURY RD SUITE 208
AVON CT
06001-3793
US

IV. Provider business mailing address

247 ROUTE 100 SUITE 1002
SOMERS NY
10589-3231
US

V. Phone/Fax

Practice location:
  • Phone: 860-409-0413
  • Fax: 860-499-5418
Mailing address:
  • Phone: 914-962-8290
  • Fax: 914-962-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number035121
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number035121
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number286455
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number286455
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: