Individual
MR. JESSE JACOB FERTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
12430 QUEENS BLVD, KEW GARDENS, NY 11415-1501
(718) 261-2344
Mailing address
12430 QUEENS BLVD, KEW GARDENS, NY 11415-1501
(718) 261-2344
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618002935
VA
152W00000X
Optometrist
105426
IA
152W00000X
Optometrist
346002045
IL
152W00000X
Optometrist
3702-35
WI
152W00000X
Optometrist
TPOP68
FL
152W00000X
Optometrist
Primary
TUV007355
NY
Other
Enumeration date
08/19/2006
Last updated
03/06/2023
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