Healthcare Provider Details

I. General information

NPI: 1134188782
Provider Name (Legal Business Name): BERNARDO FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 HEMPSTEAD TPKE
EAST MEADOW NY
11554-1859
US

IV. Provider business mailing address

135 SOUTH DR
NEW HYDE PARK NY
11040-2232
US

V. Phone/Fax

Practice location:
  • Phone: 516-572-6501
  • Fax: 516-572-5609
Mailing address:
  • Phone: 516-775-2559
  • Fax: 516-292-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number111273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: