Provider Demographics
NPI:1265505846
Name:ANDERSON, FERDINAND JR (MD)
Entity type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:
Last Name:ANDERSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HURLEY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3739
Mailing Address - Country:US
Mailing Address - Phone:845-338-5600
Mailing Address - Fax:845-338-3058
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3739
Practice Address - Country:US
Practice Address - Phone:845-338-5600
Practice Address - Fax:845-338-3058
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155348-1207R00000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW4K811Medicare ID - Type Unspecified
NYD91752Medicare UPIN