Provider Demographics
NPI:1689644973
Name:FERN, CRAIG MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MICHAEL
Last Name:FERN
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 1:105 S BEDFORD RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3441
Mailing Address - Country:US
Mailing Address - Phone:914-244-3800
Mailing Address - Fax:914-244-3596
Practice Address - Street 1:105 S BEDFORD RD
Practice Address - Street 2:SUITE 311
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3441
Practice Address - Country:US
Practice Address - Phone:914-244-3800
Practice Address - Fax:914-244-3596
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01719126Medicaid
NYF67330Medicare UPIN
NY01719126Medicaid