Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 188438-1 | NY |
N | 208000000X | Pediatrician | 188438-1 | NY |
NPI | 1215937453 |
---|---|
Provider Name | Dr. Chona Cudal Fernandez-Gulmatico |
First Address | Brooklyn, NY 11235-1709 |
Second Address | Brooklyn, NY 11235-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 17/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01723880 | (05) | NY |
BG3229867 | DEA NUMBER (01) | NY |
F31416 | (02) | NY |