Provider Demographics
NPI:1922231265
Name:FERNANDO, MARTY ANTONIO BESERIL (PT)
Entity Type:Individual
Prefix:
First Name:MARTY ANTONIO
Middle Name:BESERIL
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DOCTORS ON CALL
Mailing Address - Street 2:6010 BAY PARKWAY SUITE 901
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6081
Mailing Address - Country:US
Mailing Address - Phone:718-238-2100
Mailing Address - Fax:718-748-0863
Practice Address - Street 1:PARCARE COMMUNITY HEALTH NETWORK
Practice Address - Street 2:445 PARK AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2735
Practice Address - Country:US
Practice Address - Phone:718-963-0800
Practice Address - Fax:718-534-5221
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist