Provider Demographics
NPI:1831213230
Name:FERNANDEZ, ANDRES
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90-31 WHITNEY AVE
Mailing Address - Street 2:APT .5C
Mailing Address - City:ELMHUST
Mailing Address - State:NJ
Mailing Address - Zip Code:11373-1604
Mailing Address - Country:US
Mailing Address - Phone:212-942-0043
Mailing Address - Fax:
Practice Address - Street 1:651 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5003
Practice Address - Country:US
Practice Address - Phone:212-942-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05702211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical