Basic Information
| Provider Information | |||||||||
| NPI: | 1013143353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FEGS NASSAU CIDP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 FULTON AVE | ||||||||
| Address2: | 5TH FL. | ||||||||
| City: | HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115503718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165052003 | ||||||||
| FaxNumber: | 5165052011 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 HUDSON ST | ||||||||
| Address2: | 9TH FL. | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100131009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123668007 | ||||||||
| FaxNumber: | 2123668069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2009 | ||||||||
| LastUpdateDate: | 06/01/2009 | ||||||||
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| AuthorizedOfficialLastName: | WAIZER | ||||||||
| AuthorizedOfficialFirstName: | JONAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2123668024 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | NY | Y | Agencies | Case Management |
No ID Information.