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General NPI Number Information
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NPI Number | 1982069357
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Entity Type | Organization
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Legal Business Name | FERGUSON AND PITCH TMS MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 12/29/2015
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 1739-A NORTH OCEAN AVE
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City | MEDFORD
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State | NY
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Zip | 11763-2683
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Country | US
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Telephone | 631-509-6111
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Fax | 631-509-6112
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Provider Business Mailing Address
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Address Line | 646 MAIN STREET SUITE 201
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2203
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Country | US
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Telephone | 631-509-6111
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Fax | 631-509-6112
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Authorized Official
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Title or Position | OWNER
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Name | RENA FERGUSON
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Credential | M.D.
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Telephone | 631-509-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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