=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659578839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERNANDO TAVERAS, MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 02/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 629 W 185TH ST SUITE 3
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-928-3900
-----------------------------------------------------
Fax | 212-740-1731
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 629 W 185TH ST STE 301
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10033-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-543-3500
-----------------------------------------------------
Fax | 877-673-0925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRY
-----------------------------------------------------
Name | DR. FERNANDO T TAVERAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 212-928-3900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 213401-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------