Individual
DR. JOHN FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3959 BROADWAY, COLUMBIA UNIVERSITY DEPARTMT .PEDIATRIC, NEW YORK, NY 10032-1559
(212) 304-7250
(212) 544-1974
Mailing address
9 KOEWING PL, WEST ORANGE, NY 10032
(212) 304-7250
(212) 544-1974
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
175252
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002673
MEDICARE PTAN
NJ
05
—
01851101
—
NY
Enumeration date
02/23/2006
Last updated
03/10/2010
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