Healthcare Provider Details

I. General information

NPI: 1013409531
Provider Name (Legal Business Name): DESIREE MARIA FERDINANDI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 RIVERSIDE DR
BINGHAMTON NY
13905-4246
US

IV. Provider business mailing address

PO BOX 392587
PITTSBURGH PA
15251-9587
US

V. Phone/Fax

Practice location:
  • Phone: 518-650-7503
  • Fax:
Mailing address:
  • Phone: 844-225-7619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number2023050269
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2023050269
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number310342
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: