Provider Demographics
NPI:1063431245
Name:CRAIG M. FERN, M.D., P.C.
Entity type:Organization
Organization Name:CRAIG M. FERN, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-244-3800
Mailing Address - Street 1:105 S BEDFORD RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3441
Mailing Address - Country:US
Mailing Address - Phone:914-244-3800
Mailing Address - Fax:914-244-3596
Practice Address - Street 1:105 S BEDFORD RD
Practice Address - Street 2:SUITE 311
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3441
Practice Address - Country:US
Practice Address - Phone:914-244-3800
Practice Address - Fax:914-244-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01719126Medicaid
NYF67330Medicare UPIN
NY01719126Medicaid