Healthcare Provider Details

I. General information

NPI: 1063729366
Provider Name (Legal Business Name): MARIA L FERNANDO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 HIMROD ST
BROOKLYN NY
11237-4446
US

IV. Provider business mailing address

398 HIMROD ST
BROOKLYN NY
11237-4446
US

V. Phone/Fax

Practice location:
  • Phone: 718-386-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number154110
License Number StateNY

VIII. Authorized Official

Name: MARIA FERNANDO
Title or Position: MD
Credential:
Phone: 718-386-1111