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General NPI Number Information
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NPI Number | 1487963153
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Entity Type | Organization
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Legal Business Name | FERN PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 166 E 61ST ST
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City | NEW YORK
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State | NY
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Zip | 10065-8509
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Country | US
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Telephone | 212-207-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 166 E 61ST ST
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City | NEW YORK
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State | NY
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Zip | 10065-8509
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Country | US
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Telephone | 212-207-9200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN A. FERN
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Credential | M.D.
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Telephone | 212-207-9200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0105X
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Taxonomy Name | Surgery of the Hand (Plastic Surgery) Physician
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License Number | 188307
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 188307
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License Number State | NY
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