Provider Demographics
NPI:1174697494
Name:FERRARO, HEATHER A (PAC)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:FERRARO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NEW YORK SPINE AND BRAIN SURGERY
Mailing Address - Street 2:HSC T 12 RM 080
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8122
Mailing Address - Country:US
Mailing Address - Phone:631-444-8070
Mailing Address - Fax:631-444-1535
Practice Address - Street 1:NEW YORK SPINE AND BRAIN SURGERY
Practice Address - Street 2:HSC T12 RM 080
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8122
Practice Address - Country:US
Practice Address - Phone:631-444-8070
Practice Address - Fax:631-444-1535
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0107171363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6056L03621Medicare ID - Type Unspecified
NYQ58697Medicare UPIN