Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 38MC00674100 | NJ |
NPI | 1154586121 |
---|---|
Provider Name | Dr. Derek D Ferguson |
First Address | Jersey City, NJ 07305-0222 |
Second Address | Whippany, NJ 07981-2115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2008 |
Last Update Date | 05/03/2018 |