Healthcare Provider Details

I. General information

NPI: 1518968916
Provider Name (Legal Business Name): FENAR THEMISTOCLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1973 UNIVERSITY AVE
BRONX NY
10453-4404
US

IV. Provider business mailing address

1973 UNIVERSITY AVE BRONX, NY 10453
BRONX NY
10453-4404
US

V. Phone/Fax

Practice location:
  • Phone: 718-708-8000
  • Fax: 718-708-8001
Mailing address:
  • Phone: 718-708-8000
  • Fax: 718-708-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number217744
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number217744
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number217744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: