Active NPI
Olivia Ann Fertmann
- Specialist
- Medford, NY
National Provider Identifier
1265939904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 1119585181
- Practice address
- 1 Scouting Blvd
Medford, NY 11763-2220 - Phone
- (631) 297-3202
- NPI assigned
- Apr 10, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1119585181 | NY | Primary |
Addresses
Primary practice location
1 Scouting Blvd
Medford, NY 11763-2220
Mailing address
1 Scouting Blvd
Medford, NY 11763-2220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 119585181 | Other | NY | CERTIFICATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1119585181 | NY | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523318400000",
"number": "1265939904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 SCOUTING BLVD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117632220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 SCOUTING BLVD",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117632220",
"telephone_number": "631-297-3202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERTMANN",
"first_name": "OLIVIA",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-10",
"last_updated": "2018-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "NY",
"license": "1119585181",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFICATION",
"identifier": "119585181",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.