Provider Demographics
NPI:1528011103
Name:FEFER, JOSE JACOBO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JACOBO
Last Name:FEFER
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:PO BOX 95000-2240
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2240
Mailing Address - Country:US
Mailing Address - Phone:212-523-3847
Mailing Address - Fax:212-523-5677
Practice Address - Street 1:1111 AMSTERDAM AVE
Practice Address - Street 2:ST. LUKE'S ROOSEVELT HOSPITAL CENTER, SCRYMSER 3RD FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1716
Practice Address - Country:US
Practice Address - Phone:212-523-3847
Practice Address - Fax:212-523-5677
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243063207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02674000Medicaid
NY02674000Medicaid