Provider Demographics
NPI:1457681314
Name:JOHN R FERNANDEZ MD PLLC
Entity Type:Organization
Organization Name:JOHN R FERNANDEZ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:OROZCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-766-8995
Mailing Address - Street 1:5536 69TH PL
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1856
Mailing Address - Country:US
Mailing Address - Phone:718-533-0029
Mailing Address - Fax:718-396-2491
Practice Address - Street 1:5536 69TH PL
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1856
Practice Address - Country:US
Practice Address - Phone:718-533-0029
Practice Address - Fax:718-396-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227988207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty