Provider Demographics
NPI:1639240823
Name:FERRO, DOMINIC JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:JOSEPH
Last Name:FERRO
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 1:152 W PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2425
Mailing Address - Country:US
Mailing Address - Phone:845-623-0658
Mailing Address - Fax:
Practice Address - Street 1:152 W PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2425
Practice Address - Country:US
Practice Address - Phone:845-623-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191385-12084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09M481Medicare UPIN