Provider Demographics
NPI:1013082452
Name:FERGUSON, RENA K (MD)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:K
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1000 MAIN STREET
Mailing Address - Street 2:SUITE G
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-760-1830
Mailing Address - Fax:631-509-6080
Practice Address - Street 1:1000 MAIN STREET
Practice Address - Street 2:SUITE G
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777
Practice Address - Country:US
Practice Address - Phone:631-760-1830
Practice Address - Fax:631-509-6080
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2303302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501137Medicaid
NY388BK1Medicare PIN
I01856Medicare UPIN