Healthcare Provider Details

I. General information

NPI: 1093798548
Provider Name (Legal Business Name): JEFFREY JOSEPH FERRER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 ROUTE 55 SUITE 7A
POUGHQUAG NY
12570-9998
US

IV. Provider business mailing address

PO BOX 819
POUGHQUAG NY
12570-9998
US

V. Phone/Fax

Practice location:
  • Phone: 845-459-8400
  • Fax: 845-501-1588
Mailing address:
  • Phone: 914-373-9040
  • Fax: 845-501-1588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number044624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: