Provider Demographics
NPI:1124010822
Name:VISCO, FERDINAND (MD)
Entity Type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:
Last Name:VISCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 EUCLID RD
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6434
Mailing Address - Country:US
Mailing Address - Phone:201-886-8511
Mailing Address - Fax:
Practice Address - Street 1:90-02 QUEENS BLVD
Practice Address - Street 2:ST. JOHN'S QUEENS HOSPITAL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4941
Practice Address - Country:US
Practice Address - Phone:718-558-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113869-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00208080Medicaid
NY86896Medicare ID - Type Unspecified
NYB16731Medicare UPIN