Healthcare Provider Details

I. General information

NPI: 1730183013
Provider Name (Legal Business Name): JAMES W FERGUSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W MAIN ST
EAST ISLIP NY
11730-2216
US

IV. Provider business mailing address

1010 NORTHERN BLVD STE 328
GREAT NECK NY
11021-5329
US

V. Phone/Fax

Practice location:
  • Phone: 631-581-2049
  • Fax: 631-581-3354
Mailing address:
  • Phone: 516-233-2484
  • Fax: 516-304-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number150415
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: