Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | C-007735-6B | NY |
N | 111NS0005X | Chiropractic Sports Physician | C-007735-6B | NY |
N | 111NX0800X | Chiropractor Orthopedic Specialist | C-007735-6B | NY |
NPI | 1083734032 |
---|---|
Provider Name | Dr. John Fernandez |
First Address | Hauppauge, NY 11788-3461 |
Second Address | Woodside, NY 11377-4442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376750 | CIGNA HEALTHCARE (01) | NY |