Healthcare Provider Details

I. General information

NPI: 1053623041
Provider Name (Legal Business Name): ISLAND MEDICAL EMPIRE STATE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE NORTON AVENUE, EMERGENCY DEPARTMENT A. O. FOX MEMORIAL HOSPITAL
ONEONTA NY
13820-2629
US

IV. Provider business mailing address

350 MOTOR PKWY SUITE 309
HAUPPAUGE NY
11788-5101
US

V. Phone/Fax

Practice location:
  • Phone: 607-431-5003
  • Fax: 607-431-5058
Mailing address:
  • Phone: 631-514-7600
  • Fax: 631-813-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL R. FERRARA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 631-514-7600