Healthcare Provider Details

I. General information

NPI: 1285730366
Provider Name (Legal Business Name): FERRELL A MOTLOW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 CHURCH AVE CARRIBEAN AMERICAN FAMILY HEALTH CENTER
BROOKLYN NY
11203-2714
US

IV. Provider business mailing address

5800 3RD AVE MANAGED CARE DEPARTMENT
BROOKLYN NY
11220-3702
US

V. Phone/Fax

Practice location:
  • Phone: 718-940-9425
  • Fax:
Mailing address:
  • Phone: 718-630-7477
  • Fax: 718-630-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number224549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: