=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396037933
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN S. FERRARO, DO, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2011
-----------------------------------------------------
Last Update Date | 05/13/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 STELL LN
-----------------------------------------------------
City | EAST NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11731-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-614-8419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 STELL LN
-----------------------------------------------------
City | EAST NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11731-4510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-614-8419
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN S. FERRARO
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 718-614-8419
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 205804
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------