Individual
JUSTIN P FEDOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
5586 LEGIONNAIRE DR STE 1, CICERO, NY 13039-3504
(315) 699-2837
(315) 699-2734
Mailing address
5586 LEGIONNAIRE DR STE 1, CICERO, NY 13039-3504
(315) 699-2837
(315) 699-2734
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
265947
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
265947
LICENSE
NY
Enumeration date
06/11/2009
Last updated
09/19/2012
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