Basic Information
| Provider Information | |||||||||
| NPI: | 1043481856 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERTMAN | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | PAUL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | REGISTERED NURSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 154 W 15TH ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126277560 | ||||||||
| FaxNumber: | 2126277563 | ||||||||
| Practice Location | |||||||||
| Address1: | 154 W 15TH ST | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126277560 | ||||||||
| FaxNumber: | 2126277563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 434386 | NY | Y | Nursing Service Providers | Registered Nurse | General Practice |
No ID Information.