Provider Demographics
NPI:1417119397
Name:FERTIG, NECHAMA TAMAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NECHAMA
Middle Name:TAMAR
Last Name:FERTIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 W END AVE
Mailing Address - Street 2:APT 12 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4919
Mailing Address - Country:US
Mailing Address - Phone:212-222-0514
Mailing Address - Fax:
Practice Address - Street 1:2001 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1448
Practice Address - Country:US
Practice Address - Phone:718-339-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0536481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice