Healthcare Provider Details

I. General information

NPI: 1487963153
Provider Name (Legal Business Name): FERN PLASTIC SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 E 61ST ST
NEW YORK NY
10065-8509
US

IV. Provider business mailing address

166 E 61ST ST
NEW YORK NY
10065-8509
US

V. Phone/Fax

Practice location:
  • Phone: 212-207-9200
  • Fax:
Mailing address:
  • Phone: 212-207-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number188307
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number188307
License Number StateNY

VIII. Authorized Official

Name: STEVEN A. FERN
Title or Position: OWNER
Credential: M.D.
Phone: 212-207-9200