Healthcare Provider Details

I. General information

NPI: 1114338019
Provider Name (Legal Business Name): GEORGE SALEM FERZLI JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 135TH ST STE 2T
JAMAICA NY
11418-2828
US

IV. Provider business mailing address

150 E 69TH ST APT 9R
NEW YORK NY
10021-5722
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-7110
  • Fax:
Mailing address:
  • Phone: 646-533-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number282193
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number282193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: