1013082452 NPI number — RENA K FERGUSON MD

Table of content: RENA K FERGUSON MD (NPI 1013082452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013082452 NPI number — RENA K FERGUSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERGUSON
Provider First Name:
RENA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013082452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 E OAKLAND AVE STE 2A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT JEFFERSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11777-2602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-760-1830
Provider Business Mailing Address Fax Number:
631-509-6080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 E OAKLAND AVE STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT JEFFERSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11777-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-760-1830
Provider Business Practice Location Address Fax Number:
631-509-6080
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  230330 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02501137 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com