Provider Demographics
NPI:1760505481
Name:FORNARI, ERIC DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DANIEL
Last Name:FORNARI
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 1:3400 BAINBRIDGE AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2404
Mailing Address - Country:US
Mailing Address - Phone:718-920-5532
Mailing Address - Fax:718-920-7799
Practice Address - Street 1:3400 BAINBRIDGE AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2404
Practice Address - Country:US
Practice Address - Phone:718-920-5532
Practice Address - Fax:718-920-7799
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAN-1992975-G-119207X00000X
CAA115081207XP3100X
NY266292207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery