Healthcare Provider Details

I. General information

NPI: 1265505846
Provider Name (Legal Business Name): FERDINAND ANDERSON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HURLEY AVE SUITE 4
KINGSTON NY
12401-3739
US

IV. Provider business mailing address

40 HURLEY AVE SUITE 4
KINGSTON NY
12401-3739
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-5600
  • Fax: 845-338-3058
Mailing address:
  • Phone: 845-338-5600
  • Fax: 845-338-3058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number155348-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number155348-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: