Healthcare Provider Details

I. General information

NPI: 1285647412
Provider Name (Legal Business Name): LINCOLN FERGUSON MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 24A 126TH AVE
JAMAICA NY
11434
US

IV. Provider business mailing address

176 24A 126TH AVE
JAMAICA NY
11434
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-1230
  • Fax: 718-949-2035
Mailing address:
  • Phone: 718-949-1230
  • Fax: 718-949-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number219794
License Number StateNY

VIII. Authorized Official

Name: DR. LINCOLN J FERGUSON
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 718-949-1230