Individual
IVAN J FERNANDEZ-MADRID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
380 2ND AVE, NEW YORK, NY 10010-5615
(212) 598-6655
Mailing address
205 EAST 16TH STREET, SUITE M1B, NEW YORK, NY 10003
(212) 254-0946
(212) 254-0956
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
217407
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217407
MEDICAL LICENSE
NY
01
—
390091P
HIP PROVIDER PRIS#
NY
01
—
857G9
EMPIRE BLUE CROSS BLUE SHIELD
NY
01
—
P2384505
OXFORD
NY
Enumeration date
06/14/2006
Last updated
08/10/2022
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