Healthcare Provider Details

I. General information

NPI: 1427095785
Provider Name (Legal Business Name): FERNANDO J CAMACHO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E 208TH ST
BRONX NY
10467-2702
US

IV. Provider business mailing address

60 E 208TH ST
BRONX NY
10467-2702
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-1700
  • Fax: 718-405-7231
Mailing address:
  • Phone: 718-405-1700
  • Fax: 718-405-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number124277
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: