Healthcare Provider Details

I. General information

NPI: 1104036680
Provider Name (Legal Business Name): RINET PHILOMENA FERNANDES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 KEARNY AVE FL 1
KEARNY NJ
07032-3148
US

IV. Provider business mailing address

4 TANGER DR
LIVINGSTON NJ
07039-1429
US

V. Phone/Fax

Practice location:
  • Phone: 201-299-2249
  • Fax: 201-299-2251
Mailing address:
  • Phone: 862-228-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08562800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: