Provider Demographics
NPI:1568537231
Name:FERGUSON, EVETTE WEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:EVETTE
Middle Name:WEIL
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVETTE
Other - Middle Name:
Other - Last Name:WEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:535 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:212-774-7640
Mailing Address - Fax:212-774-2880
Practice Address - Street 1:535 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-774-7640
Practice Address - Fax:212-774-2880
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWANX81OtherMEDICARE GROUP PIN
NYEW0287SH10Medicare PIN
NY287SH1Medicare PIN