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General NPI Number Information
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NPI Number | 1568796449
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Entity Type | Organization
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Legal Business Name | FS PHYSICIAN MEDICAL
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Dates
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Enumeration Date | 09/25/2009
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Last Update Date | 09/25/2009
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Provider Practice Location Address
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Address Line | 203 BIRCH DR
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-2346
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Country | US
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Telephone | 516-972-2215
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Fax |
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Provider Business Mailing Address
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Address Line | 461 PARK AVE S 11TH FLOOR
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City | NEW YORK
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State | NY
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Zip | 10016-6822
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Country | US
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Telephone | 212-473-6500
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Fax | 212-529-3016
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Authorized Official
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Title or Position | CEO
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Name | DR. HENRY FERSTENBERG
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Credential | M.D.
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Telephone | 516-972-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 139924
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License Number State | NY
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