Provider Demographics
NPI:1912395112
Name:FERNANDEZ, MANUEL
Entity Type:Individual
Prefix:
First Name:MANUEL
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 1:1944 UNIONPORT RD
Mailing Address - Street 2:APT.S2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2850
Mailing Address - Country:US
Mailing Address - Phone:347-644-3508
Mailing Address - Fax:
Practice Address - Street 1:4 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1222
Practice Address - Country:US
Practice Address - Phone:914-663-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator