Healthcare Provider Details

I. General information

NPI: 1174697494
Provider Name (Legal Business Name): HEATHER A FERRARO PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NEW YORK SPINE AND BRAIN SURGERY HSC T12 RM 080
STONY BROOK NY
11794-8122
US

IV. Provider business mailing address

NEW YORK SPINE AND BRAIN SURGERY HSC T 12 RM 080
STONY BROOK NY
11794-8122
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-8070
  • Fax: 631-444-1535
Mailing address:
  • Phone: 631-444-8070
  • Fax: 631-444-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0107171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: