MEDICARE: HENRY FERNANDEZ-COS, MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA04426200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0650430001	OTHER	NJ	AMERIHEALTH GROUP# (WNY)
2	0650430003	OTHER	NJ	AMERIHEALTH GROUP (ENGLE)

General Provider Information

NPI Number	:	1144267659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY FERNANDEZ-COS, MD PA

Provider Business Mailing Address
First Line	:	419 66TH ST
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2401
Country	:	US
Telephone Number	:	201-861-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 66TH ST
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2401
Country	:	US
Telephone Number	:	201-861-9229
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HENRY FERNANDEZ-COS
Credential	:	MD
Telephone Number	:	201-861-9229

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	04/11/2008

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