Individual
GEORGE G FAIREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1227 MAIN ST STE 202, PORT JEFFERSON, NY 11777-2227
(631) 689-5155
Mailing address
1227 MAIN ST STE 202, PORT JEFFERSON, NY 11777-2227
(631) 689-5155
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
129972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00509146
—
NY
Enumeration date
04/07/2008
Last updated
09/10/2008
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