1285647412 NPI number — LINCOLN FERGUSON MD,PC

Table of content: CINDY DUONG MEDICAL STUDENT, DO (NPI 1356111652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285647412 NPI number — LINCOLN FERGUSON MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN FERGUSON MD,PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285647412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
176 24A 126TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-949-1230
Provider Business Mailing Address Fax Number:
718-949-2035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 24A 126TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-949-1230
Provider Business Practice Location Address Fax Number:
718-949-2035
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FERGUSON
Authorized Official First Name:
LINCOLN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
718-949-1230

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  219794 , 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: 5B8051 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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