Provider Demographics
NPI:1083734032
Name:FERNANDEZ, JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PIA CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3461
Mailing Address - Country:US
Mailing Address - Phone:631-793-2087
Mailing Address - Fax:718-478-8672
Practice Address - Street 1:4322 50TH ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4442
Practice Address - Country:US
Practice Address - Phone:718-424-4455
Practice Address - Fax:718-478-8672
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-007735-6B111NN0400X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurology
Not Answered111NS0005XChiropractic ProvidersChiropractorSports Physician
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1376750OtherCIGNA HEALTHCARE