Provider Demographics
NPI:1265855597
Name:FENAR THEMISTOCLE MD PLLC
Entity Type:Organization
Organization Name:FENAR THEMISTOCLE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FENAR
Authorized Official - Middle Name:F
Authorized Official - Last Name:THEMISTOCLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-590-0371
Mailing Address - Street 1:1973 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4404
Mailing Address - Country:US
Mailing Address - Phone:347-730-4606
Mailing Address - Fax:
Practice Address - Street 1:1973 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4404
Practice Address - Country:US
Practice Address - Phone:347-730-4606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217744174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty