Provider Demographics
NPI:1568796449
Name:FS PHYSICIAN MEDICAL
Entity Type:Organization
Organization Name:FS PHYSICIAN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERSTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-972-2215
Mailing Address - Street 1:461 PARK AVE S
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6822
Mailing Address - Country:US
Mailing Address - Phone:212-473-6500
Mailing Address - Fax:212-529-3016
Practice Address - Street 1:203 BIRCH DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2346
Practice Address - Country:US
Practice Address - Phone:516-972-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY176352OtherSHELBY SAMUEL LICENSE
NY139924OtherLICENSE