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NPI Code Detail

MEDICARE: FEKADE TEFERA PHYSICIAN, P.C.

MEDICARE: FEKADE TEFERA PHYSICIAN, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275686131
Entity Type Code : Organization
Provider Name (Legal Business Name) : FEKADE TEFERA PHYSICIAN, P.C.
Provider Business Mailing Address
First Line : 148 CRESCENT AVE
Second Line :
City : EAST BRUNSWICK
State : NJ
Zip : 08816-5416
Country : US
Telephone Number : 732-251-2048
Fax Number :
Provider Business Practice Location Address
First Line : 1222 E 96TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-3903
Country : US
Telephone Number : 718-874-7095
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. FEKADE TEFERA
Credential : M.D.
Telephone Number : 732-251-2048
Provider Enumeration Date : 01/22/2007
Last Update Date : 03/26/2008

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