1083734032 NPI number — DR. JOHN FERNANDEZ D.C.

Table of content: DR. JOHN FERNANDEZ D.C. (NPI 1083734032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083734032 NPI number — DR. JOHN FERNANDEZ D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083734032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PIA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-3461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-793-2087
Provider Business Mailing Address Fax Number:
718-478-8672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4322 50TH ST
Provider Second Line Business Practice Location Address:
SUITE 1-B
Provider Business Practice Location Address City Name:
WOODSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11377-4442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-424-4455
Provider Business Practice Location Address Fax Number:
718-478-8672
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X , with the licence number:  C-007735-6B , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NS0005X , with the licence number: C-007735-6B , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111NX0800X , with the licence number: C-007735-6B , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1376750 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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