Provider Demographics
NPI:1316194848
Name:FONTECHA HERNANDEZ, JEISSON FERNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEISSON
Middle Name:FERNEY
Last Name:FONTECHA HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N STE 350A
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3814
Mailing Address - Country:US
Mailing Address - Phone:516-663-2691
Mailing Address - Fax:
Practice Address - Street 1:222 STATION PLZ N STE 350A
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3814
Practice Address - Country:US
Practice Address - Phone:516-663-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2776892084P0800X
FLTRN12607390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry