Individual
LUIS FERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
45 CYPRESS AVE, BOGOTA, NJ 07603-1801
(646) 755-5999
Mailing address
45 CYPRESS AVE, BOGOTA, NJ 07603-1801
(646) 755-5999
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
Other
Enumeration date
11/29/2023
Last updated
01/07/2024
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