Healthcare Provider Details

I. General information

NPI: 1487156634
Provider Name (Legal Business Name): FERGUSON LIFE HEALTH CENTERS OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 ALLAMANDA DR
DELRAY BEACH FL
33483-4914
US

IV. Provider business mailing address

PO BOX 269
CEDAR KNOLLS NJ
07927-0269
US

V. Phone/Fax

Practice location:
  • Phone: 973-210-3838
  • Fax:
Mailing address:
  • Phone: 973-210-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA ORTIZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 201-716-9199