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General NPI Number Information
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NPI Number | 1346405347
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Entity Type | Individual
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Provider Name | JUAN JOSE GILBERT FERNANDEZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2008
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 240 PATCHOGUE YAPHANK RD STE 102
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4864
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Country | US
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Telephone | 201-682-9885
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Fax | 631-447-9843
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Provider Business Mailing Address
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Address Line | 240 PATCHOGUE YAPHANK RD STE 102
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City | EAST PATCHOGUE
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State | NY
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Zip | 11772-4864
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Country | US
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Telephone | 201-682-9885
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Fax | 631-447-9843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 273189-1
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License Number State | NY
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