Provider Demographics
NPI:1013143353
Name:FEGS NASSAU CIDP
Entity Type:Organization
Organization Name:FEGS NASSAU CIDP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WAIZER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:212-366-8024
Mailing Address - Street 1:175 FULTON AVE
Mailing Address - Street 2:5TH FL.
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3718
Mailing Address - Country:US
Mailing Address - Phone:516-505-2003
Mailing Address - Fax:516-505-2011
Practice Address - Street 1:315 HUDSON ST
Practice Address - Street 2:9TH FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1009
Practice Address - Country:US
Practice Address - Phone:212-366-8007
Practice Address - Fax:212-366-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management