Provider Demographics
NPI:1629182654
Name:SITOY, FERNANDO R (MD)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:R
Last Name:SITOY
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 1:1630 NEW DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2331
Mailing Address - Country:US
Mailing Address - Phone:732-572-2990
Mailing Address - Fax:732-572-1900
Practice Address - Street 1:1630 NEW DURHAM RD
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2331
Practice Address - Country:US
Practice Address - Phone:732-572-2990
Practice Address - Fax:732-572-1900
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03107200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2852900Medicaid
SI472187Medicare ID - Type Unspecified
F13770Medicare UPIN