Provider Demographics
NPI:1881698157
Name:FERNANDEZ-COS, HENRY
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:FERNANDEZ-COS
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 1:419 66TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2401
Mailing Address - Country:US
Mailing Address - Phone:201-861-9229
Mailing Address - Fax:201-861-9272
Practice Address - Street 1:419 66TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2401
Practice Address - Country:US
Practice Address - Phone:201-861-9229
Practice Address - Fax:201-861-9272
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04426200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11737OtherUHP #
NJ3232808Medicaid
NJ55D651OtherEMPIRE BC/BS # WNY
NJ55D653OtherEMPIRE BC/BS # ENGLEWOOD
NJJ38367OtherHEALTHNET #
NJ044262OtherHIP PROVIDER #
NJ0650430001OtherAMERIHEALTH #
NJ4207231OtherAETNA PPO #
NJ9537733OtherGHI PPO #
NJ2223587OtherAETNA HMO #
NJP771423OtherOXFORD PROVIDER #
NJJ38367OtherHEALTHNET #
NJ55D653OtherEMPIRE BC/BS # ENGLEWOOD