Provider Demographics
NPI:1174566178
Name:FERGUSON, RAYMOND G JR (DPM)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:G
Last Name:FERGUSON
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:700 HICKSVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3472
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-1617
Practice Address - Country:US
Practice Address - Phone:516-742-3100
Practice Address - Fax:516-240-7839
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005769213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPG5421Medicare ID - Type Unspecified
NYU87257Medicare UPIN