Provider Demographics
NPI:1366004061
Name:FERNANDEZ, NADIRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIRA
Middle Name:M
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 SPARTA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1790
Mailing Address - Country:US
Mailing Address - Phone:973-729-2121
Mailing Address - Fax:973-729-3454
Practice Address - Street 1:89 SPARTA AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1790
Practice Address - Country:US
Practice Address - Phone:973-729-2121
Practice Address - Fax:973-729-3454
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11444300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics