Provider Demographics
NPI:1497729081
Name:FERZLI, GEORGE S (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:S
Last Name:FERZLI
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 1:65 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3944
Mailing Address - Country:US
Mailing Address - Phone:718-667-8100
Mailing Address - Fax:718-667-6280
Practice Address - Street 1:65 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3944
Practice Address - Country:US
Practice Address - Phone:718-667-8100
Practice Address - Fax:718-667-6280
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149264174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00867996Medicaid
NY29D361Medicare ID - Type Unspecified
NY00867996Medicaid