Provider Demographics
NPI:1598873309
Name:FERNANDEZ, BYRON A (MD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BYRON
Other - Middle Name:
Other - Last Name:FERNENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:95 BRADHURST AVE
Mailing Address - Street 2:BLYTHEDALE CHILDREN'S HOSPITAL
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-592-7555
Mailing Address - Fax:866-310-5326
Practice Address - Street 1:95 BRADHURST AVE
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1637
Practice Address - Country:US
Practice Address - Phone:914-592-7555
Practice Address - Fax:866-310-5326
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233123208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749788Medicaid
NY511271Medicare ID - Type Unspecified
NY01749788Medicaid