Justin Philip Fedor (NPI# 1982831483, PAC ID# 6103075056) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1982831483 |
| PAC ID by PECOS | 6103075056 |
| Professional Enrollment ID | I20121009000440 |
| Full Name | Justin Philip Fedor |
| Organization Legal Name | PORT CITY EMERGENCY PHYSICIANS LLP |
| Address |
510 S 4th St Fulton NY 13069-2904 |
| Phone Number | 3155923510 |
| Gender | M |
| Medical School | NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY |
| Graduation Year | 2009 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 0345301917 |
| Number of Group Practice Members | 31 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 330218 | OSWEGO HOSPITAL |
| 330307 | CAYUGA MEDICAL CENTER AT ITHACA |
| Address | Phone | Organization |
|---|---|---|
| 5586 Legionnaire Dr, Suite 1, Cicero, NY 13039-3504 | 3156992837 | ST JOSEPHS MEDICAL PC |
| 1129 Commons Ave, Cortland, NY 13045-1651 | 6077567200 | CAYUGA EMERGENCY PHYSICIANS, LLP |
| 510 S 4th St, Fulton, NY 13069-2904 | 3155923510 | PORT CITY EMERGENCY PHYSICIANS LLP |
| 101 Dates Dr, Ithaca, NY 14850-1342 | 6072744011 | CAYUGA EMERGENCY PHYSICIANS, LLP |
| 110 W 6th St, Oswego, NY 13126-2507 | 3153495511 | PORT CITY EMERGENCY PHYSICIANS LLP |
| Organization Legal Name | PORT CITY EMERGENCY PHYSICIANS LLP |
| Physicians | 34 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bethany A Hawke | Emergency Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Jennifer Drake | Nurse Practitioner | Port City Emergency Physicians LLP | 3045 E Ave, Central Square, NY 13036-9502 |
| Rebecca L Dottolo | Nurse Practitioner | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Richard H Koehler | Emergency Medicine | Port City Emergency Physicians LLP | 110 W 6th St, Oswego, NY 13126-2507 |
| Colin Coniski | Physician Assistant | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Megan R Coghlan | Nurse Practitioner | Port City Emergency Physicians LLP | 110 W 6th St, Oswego, NY 13126-2507 |
| Nathaniel Michael Farden | Nurse Practitioner | Port City Emergency Physicians LLP | 110 W 6th St, Oswego, NY 13126-2507 |
| Casey N Moore | Emergency Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Dastagir Alam Khan | Internal Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Anton Chertkovsky | Physician Assistant | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Street Address |
510 S 4TH ST |
| City | FULTON |
| State | NY |
| Zip | 13069-2904 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Bethany A Hawke | Emergency Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Rebecca L Dottolo | Nurse Practitioner | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Colin Coniski | Physician Assistant | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Casey N Moore | Emergency Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Dastagir Alam Khan | Internal Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Anton Chertkovsky | Physician Assistant | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| James Y Yarovoy | Emergency Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Teresa M Ainsworth | Emergency Medicine | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Barbara A Martin | Nurse Practitioner | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Sanjeev K Verma | Anesthesiology | Port City Emergency Physicians LLP | 510 S 4th St, Fulton, NY 13069-2904 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joshua H Blodgett | Nurse Practitioner | Liberty Resources Inc. | 1850 Cnty Rte, Suite 57, Fulton, NY 13069 |
| Angelique Chambers | Clinical Social Worker | Liberty Resources Inc. | 1850 Cnty Rte, Suite 57, Fulton, NY 13069 |
| Christian L Holcomb | Family Medicine | Northway Medical Associates, Pllc | 21 N 2nd St, Fulton, NY 13069-1250 |
| Rajeev Saini | Internal Medicine | Northway Medical Associates, Pllc | 21 N 2nd St, Fulton, NY 13069-1250 |
| Katherine Mcphee | Nurse Practitioner | Northway Medical Associates, Pllc | 21 N 2nd St, Fulton, NY 13069-1250 |
| Suryakant Z Patel | Family Medicine | Northway Medical Associates, Pllc | 21 N 2nd St, Fulton, NY 13069-1250 |
| Brittany J Todd | Physician Assistant | Northway Medical Associates, Pllc | 21 N 2nd St, Fulton, NY 13069-1250 |
| Sushma Sapkota Pandey | Internal Medicine | Northway Medical Associates, Pllc | 21 N 2nd St, Fulton, NY 13069-1250 |
| Douglas J Dickson | Podiatry | 98 N 2nd St, Suite 101, Fulton, NY 13069-1254 | |
| Karl F Hafner | Family Practice | 98 N 2nd St, Fulton, NY 13069-1254 | |
| Find all physicians in zip 13069 | |||
| City | FULTON |
| Zip Code | 13069 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | FULTON + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Justin Philip Fedor.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.