Provider Demographics
NPI:1508006453
Name:RICHARD FERSTENBERG, MD, PC
Entity Type:Organization
Organization Name:RICHARD FERSTENBERG, MD, PC
Other - Org Name:RICHARD FERSTENBERG, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:FERSTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-867-7849
Mailing Address - Street 1:424 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-5217
Mailing Address - Country:US
Mailing Address - Phone:516-867-7849
Mailing Address - Fax:516-867-3813
Practice Address - Street 1:424 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-5217
Practice Address - Country:US
Practice Address - Phone:516-867-7849
Practice Address - Fax:516-867-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160010207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E48960Medicare UPIN