Provider Demographics
NPI:1619563418
Name:FERGUSON, AMBER C
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:C
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5440
Mailing Address - Country:US
Mailing Address - Phone:347-453-1935
Mailing Address - Fax:
Practice Address - Street 1:1439 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5440
Practice Address - Country:US
Practice Address - Phone:732-523-2327
Practice Address - Fax:732-544-0364
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1740800713374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1740800713OtherTECHNICIAN