Provider Demographics
NPI:1881826956
Name:FERENCHAK, RALPH PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:PAUL
Last Name:FERENCHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:PAUL
Other - Last Name:FERENCHAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5695 BULL HILL RD
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:NY
Mailing Address - Zip Code:13084-9779
Mailing Address - Country:US
Mailing Address - Phone:315-510-2061
Mailing Address - Fax:
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-624-5226
Practice Address - Fax:315-624-5279
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1167742086S0129X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00570489Medicaid
NYJ400052944Medicare PIN