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General NPI Number Information
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NPI Number | 1861432395
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Entity Type | Organization
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Legal Business Name | NEW YORK FERTILITY PLLC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 108-48 70TH RD
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City | FOREST HILLS
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State | NY
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Zip | 11375-3961
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Country | US
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Telephone | 718-793-7752
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 750039
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City | FOREST HILLS
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State | NY
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Zip | 11375-0039
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Country | US
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Telephone | 718-793-7752
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Fax |
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Authorized Official
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Title or Position | BILLING/CREDENTIALING MGR.
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Name | MR. VINCENT FERGUSON
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Credential |
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Telephone | 813-938-5693
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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 | 212419
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License Number State | NY
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