Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 111274 | NY |
NPI | 1003981531 |
---|---|
Provider Name | Dr. Raul Fernando |
First Address | Huntington, NY 11743-2787 |
Second Address | Huntington, NY 11743-2787 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C12111 | (02) |