Provider Demographics
NPI:1073884953
Name:FERTILIEN, STANLEY (RT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:FERTILIEN
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2533
Mailing Address - Country:US
Mailing Address - Phone:917-600-0759
Mailing Address - Fax:
Practice Address - Street 1:25 ROBERT PITT DR STE 109
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3366
Practice Address - Country:US
Practice Address - Phone:845-625-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0045262278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care