Provider Demographics
NPI:1659578839
Name:FERNANDO TAVERAS, MD PC
Entity Type:Organization
Organization Name:FERNANDO TAVERAS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-928-3900
Mailing Address - Street 1:130 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1229
Mailing Address - Country:US
Mailing Address - Phone:201-585-8990
Mailing Address - Fax:212-740-1731
Practice Address - Street 1:629 W 185TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033
Practice Address - Country:US
Practice Address - Phone:212-928-3900
Practice Address - Fax:212-740-1731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213401-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1076790OtherAFFINITY HEALTH ID
NY213401-01OtherMEDICAL LICENSE NUMBER
NY21340101OtherNEIGHBORHOOD PROVIDER ID
NY01978243Medicaid
NY98P5411OtherNY PRESBYTARIAN HEALTH ID
NY03331968Medicaid
NY213401-A26OtherHEALTH FIRST PROVIDER ID
NY0000213401-01OtherCOMMUNITY PREMIER PLUS ID
NYN376961OtherWELLCARE PROVIDER ID
NYN376961OtherWELLCARE PROVIDER ID
NY03331968Medicaid
NY0000213401-01OtherCOMMUNITY PREMIER PLUS ID
NY213401-A26OtherHEALTH FIRST PROVIDER ID