Jesse Jacob Fertig OD

NPI 1366557738 - Optometrist - 152W00000X

NPI Details
NPI 1366557738
Gender Male
Enumeration Date 08/19/2006
Last Updated 11/16/2009
Entity Type Individual
Active Over 10 years ago
Practice Location
12430 QUEENS BLVD
KEW GARDENS NY, 11415-1501, US
Phone (718) 261-2344
Fax
Business Location
12430 QUEENS BLVD
KEW GARDENS NY, 11415-1501, US
Phone (718) 261-2344
Fax
Toxanomy
Taxonomy Code 152W00000X
License State Illinois
License Number 346002045
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According to our database, Mr. Jesse Jacob Fertig OD NPI is 1366557738, taxonomy code is 152W00000X and license number is 346002045, license state is located at Illinois. Jesse Jacob Fertig OD physically located at 12430 Queens Blvd, Kew Gardens NY, 11415-1501. NPI Number Jesse Jacob Fertig OD has the Individual type.

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1366557738 NPI number is provided on an as is basis without warranty of any kind. 1366557738 is maintained by the National Plan & Provider Enumeration System. The contents of Jesse Jacob Fertig OD are for informational purposes only.