Provider Demographics
NPI:1558020701
Name:FERNANDES, HENRIQUE (PA)
Entity Type:Individual
Prefix:
First Name:HENRIQUE
Middle Name:
Last Name:FERNANDES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 JERSEY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-2014
Mailing Address - Country:US
Mailing Address - Phone:973-818-8770
Mailing Address - Fax:
Practice Address - Street 1:714 JERSEY ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NJ
Practice Address - Zip Code:07029-2014
Practice Address - Country:US
Practice Address - Phone:973-818-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program