Provider Demographics
NPI:1942205216
Name:FERRIS, BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:FERRIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 ELDER DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2309
Mailing Address - Country:US
Mailing Address - Phone:631-864-8509
Mailing Address - Fax:516-520-1623
Practice Address - Street 1:2545 HEMPSTEAD TPKE
Practice Address - Street 2:STE LL3
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2143
Practice Address - Country:US
Practice Address - Phone:516-520-1605
Practice Address - Fax:516-520-1623
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY24736OtherVYTRA
NYP1055111OtherOXFORD
NY126052OtherACN
NY806392OtherMPN
NYBF0X223730OtherBS
NYBF0X223730OtherCOM
NY60054OtherAETNA
NY5808679OtherGHI
NY806392OtherMPN
NYT52665Medicare UPIN