Healthcare Provider Details

I. General information

NPI: 1053323840
Provider Name (Legal Business Name): CHARLES FERRER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 CENTRAL AVE
BETHPAGE NY
11714-3927
US

IV. Provider business mailing address

635 BELLE TERRE RD SUITE 204
PORT JEFFERSON NY
11777-1935
US

V. Phone/Fax

Practice location:
  • Phone: 516-758-8600
  • Fax:
Mailing address:
  • Phone: 631-474-0008
  • Fax: 631-474-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008913-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: