Provider Demographics
NPI:1932121779
Name:FERSTENBERG, HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:FERSTENBERG
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 1:20 EAST 46TH STREET
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9249
Mailing Address - Country:US
Mailing Address - Phone:212-768-0562
Mailing Address - Fax:516-877-8119
Practice Address - Street 1:20 EAST 46TH STREET
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-9249
Practice Address - Country:US
Practice Address - Phone:212-768-0562
Practice Address - Fax:516-877-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139924208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00767102Medicaid
NYWBW141Medicare ID - Type Unspecified
NY00767102Medicaid