Provider Demographics
NPI:1518968916
Name:THEMISTOCLE, FENAR (MD)
Entity Type:Individual
Prefix:
First Name:FENAR
Middle Name:
Last Name:THEMISTOCLE
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 1:1973 UNIVERSITY AVE
Mailing Address - Street 2:BRONX, NY 10453
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-4404
Mailing Address - Country:US
Mailing Address - Phone:718-708-8000
Mailing Address - Fax:718-708-8001
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:718-708-8000
Practice Address - Fax:718-708-8001
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217744207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02161351Medicaid