Provider Demographics
NPI:1366563686
Name:FERDICO, ENRICO (DC)
Entity type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:
Last Name:FERDICO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3716
Mailing Address - Country:US
Mailing Address - Phone:718-837-3700
Mailing Address - Fax:718-837-0324
Practice Address - Street 1:1736 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3716
Practice Address - Country:US
Practice Address - Phone:718-837-3700
Practice Address - Fax:718-837-0324
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX49311Medicare ID - Type Unspecified