Provider Demographics
NPI:1780743518
Name:FERN, STEVEN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANDREW
Last Name:FERN
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 1:166 E 61ST ST
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-8509
Mailing Address - Country:US
Mailing Address - Phone:212-207-9200
Mailing Address - Fax:212-207-9252
Practice Address - Street 1:166 E 61ST ST
Practice Address - Street 2:SUITE 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8509
Practice Address - Country:US
Practice Address - Phone:212-207-9200
Practice Address - Fax:212-207-9252
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188307208200000X, 2082S0105X
CT0404243208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45380Medicare UPIN
NY28L751Medicare ID - Type UnspecifiedMEDICARE PROVIDER # (NY)