Provider Demographics
NPI:1740432830
Name:FERST, DEREK MATTHEW (MS,CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:MATTHEW
Last Name:FERST
Suffix:
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 S HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2228
Mailing Address - Country:US
Mailing Address - Phone:914-924-7284
Mailing Address - Fax:
Practice Address - Street 1:92 S HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2228
Practice Address - Country:US
Practice Address - Phone:914-924-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012101-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist