1881698157 NPI number — DR. HENRY FERNANDEZ-COS

Table of content: DR. HENRY FERNANDEZ-COS (NPI 1881698157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881698157 NPI number — DR. HENRY FERNANDEZ-COS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERNANDEZ-COS
Provider First Name:
HENRY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
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:
1881698157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 66TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST NEW YORK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07093-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-861-9229
Provider Business Mailing Address Fax Number:
201-861-9272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 66TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST NEW YORK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07093-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-861-9229
Provider Business Practice Location Address Fax Number:
201-861-9272
Provider Enumeration Date:
06/02/2005

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: 174400000X , with the licence number:  25MA04426200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11737 . This is a "UHP #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3232808 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55D651 . This is a "EMPIRE BC/BS # WNY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 55D653 . This is a "EMPIRE BC/BS # ENGLEWOOD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: J38367 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 044262 . This is a "HIP PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0650430001 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4207231 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 9537733 . This is a "GHI PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2223587 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P771423 . This is a "OXFORD PROVIDER #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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