MEDICARE: JAMES W FERGUSON MD

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
1	207Q00000X	Family Medicine Physician	150415	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1730183013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W FERGUSON MD

Provider Business Mailing Address
First Line	:	1010 NORTHERN BLVD STE 328
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-5329
Country	:	US
Telephone Number	:	516-233-2484
Fax Number	:	516-304-5850

Provider Business Practice Location Address
First Line	:	170 W MAIN ST
Second Line	:
City	:	EAST ISLIP
State	:	NY
Zip	:	11730-2216
Country	:	US
Telephone Number	:	631-581-2049
Fax Number	:	631-581-3354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	10/22/2024

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