Provider Demographics
NPI:1679538490
Name:FEFFERMAN, NANCY R
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:FEFFERMAN
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 1:360 E 72ND ST
Mailing Address - Street 2:#A811
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4753
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 E 72ND ST
Practice Address - Street 2:#A811
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4753
Practice Address - Country:US
Practice Address - Phone:212-263-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1972562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01760127Medicaid
NYG45728Medicare UPIN
NY608431Medicare ID - Type Unspecified