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General NPI Number Information
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NPI Number | 1891937546
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Entity Type | Organization
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Legal Business Name | BIENVENIDO FAJARDO, M.D.P.C.
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 08/23/2018
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Provider Practice Location Address
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Address Line | 37 NAGLE AVE APT 1D
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City | NEW YORK
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State | NY
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Zip | 10040
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Country | US
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Telephone | 212-942-0808
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Fax | 212-942-1553
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Provider Business Mailing Address
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Address Line | 37 NAGLE AVE APT 1D
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City | NEW YORK
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State | NY
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Zip | 10040-1483
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Country | US
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Telephone | 212-942-0808
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Fax | 212-942-1553
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BIENVENIDO FAJARDO
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Credential | MD
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Telephone | 212-942-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 163674
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License Number State | NY
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