Healthcare Provider Details

I. General information

NPI: 1497729081
Provider Name (Legal Business Name): GEORGE S. FERZLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CROMWELL AVE
STATEN ISLAND NY
10304-3944
US

IV. Provider business mailing address

65 CROMWELL AVE
STATEN ISLAND NY
10304-3944
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-8100
  • Fax: 718-667-6280
Mailing address:
  • Phone: 718-667-8100
  • Fax: 718-667-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number149264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: