Individual
BISMALIA IVON FERNANDEZ THEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SA-C
Contact information
Practice address
3405 KOSSUTH AVE APT F, BRONX, NY 10467-2444
(551) 482-7078
Mailing address
3405 KOSSUTH AVE APT F, BRONX, NY 10467-2444
(551) 482-7078
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
18-121
NY
363AS0400X
Surgical Physician Assistant
Primary
001285-P.A.
PR
Other
Enumeration date
02/21/2023
Last updated
02/21/2023
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