MEDICARE: DR. CHONA CUDAL FERNANDEZ-GULMATICO MD

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	208000000X	Pediatrics Physician	188438-1	NY
2	207K00000X	Allergy & Immunology Physician	188438-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215937453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHONA CUDAL FERNANDEZ-GULMATICO MD

Provider Business Mailing Address
First Line	:	3103 EMMONS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1709
Country	:	US
Telephone Number	:	646-680-2888
Fax Number	:	516-542-5556

Provider Business Practice Location Address
First Line	:	3103 EMMONS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1709
Country	:	US
Telephone Number	:	718-240-2000
Fax Number	:	718-240-2260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/07/2023

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