Healthcare Provider Details

I. General information

NPI: 1831396142
Provider Name (Legal Business Name): HILDA ELENA FERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

622 W 168TH ST PH-4, SUITE 124
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3273
  • Fax: 212-305-6692
Mailing address:
  • Phone: 212-305-3273
  • Fax: 212-305-6692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number274374
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number274374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: