Individual
BIENVENIDO FAJARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
37 NAGLE AVE APT 1D, NEW YORK, NY 10040
(212) 942-0808
(212) 942-1553
Mailing address
37 NAGLE AVE APT 1D, NEW YORK, NY 10040-1483
(212) 942-0808
(212) 942-1553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
163674-1
NY
207RN0300X
Nephrology Physician
163674
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016260
—
NY
Enumeration date
10/04/2006
Last updated
08/23/2018
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