Healthcare Provider Details

I. General information

NPI: 1619297975
Provider Name (Legal Business Name): FERNANDO SUAREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 W 6TH ST
BROOKLYN NY
11204-4802
US

IV. Provider business mailing address

1407 W 6TH ST
BROOKLYN NY
11204-4802
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-6994
  • Fax: 718-256-4912
Mailing address:
  • Phone: 718-236-6994
  • Fax: 718-256-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA12026800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME116606
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number275225
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: