Provider Demographics
NPI:1407034846
Name:FERD, YEFIM
Entity Type:Individual
Prefix:
First Name:YEFIM
Middle Name:
Last Name:FERD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 NOSTRAND AVE
Mailing Address - Street 2:#4E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5383
Mailing Address - Country:US
Mailing Address - Phone:718-368-0917
Mailing Address - Fax:
Practice Address - Street 1:3645 NOSTRAND AVE
Practice Address - Street 2:#4E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-5383
Practice Address - Country:US
Practice Address - Phone:718-368-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY934369133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered