Healthcare Provider Details

I. General information

NPI: 1598873309
Provider Name (Legal Business Name): BYRON A FERNANDEZ MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BYRON FERNENDEZ MD.

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRADHURST AVE
VALHALLA NY
10595-1637
US

IV. Provider business mailing address

95 BRADHURST AVE BLYTHEDALE CHILDREN'S HOSPITAL
VALHALLA NY
10595
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-7555
  • Fax: 866-310-5326
Mailing address:
  • Phone: 914-592-7555
  • Fax: 866-310-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number233123
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01749788
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: