Icilma V Fergus, MD, PLLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

206086-1 Issued in NY

Legal business name

ICILMA V FERGUS, MD, PLLC

Practice address

5801 Main St
Flushing, NY 11355-5333

Phone

(212) 561-5792

Fax

(347) 923-9525

NPI assigned

Jan 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Icilma V Fergus, MDNPI 1699745075

Title

Ceo

Phone

(718) 670-1234

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Icilma Fergus, M.D.

  • Cardiovascular Disease Physician
  • New York, NY
  • NPI 1699745075
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952457525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 WAGON WHEEL DR",
            "city": "NEW CITY",
            "state": "NY",
            "postal_code": "109561315",
            "telephone_number": "718-670-1234",
            "fax_number": "718-661-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 MAIN ST",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113555333",
            "telephone_number": "212-561-5792",
            "fax_number": "347-923-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICILMA V FERGUS, MD, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FERGUS",
        "authorized_official_first_name": "ICILMA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-670-1234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NY",
            "license": "206086-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cardiovascular Disease Physician in Flushing, NY
• Providers in Flushing, NY by specialty
• Cardiovascular Disease Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.