MEDICARE: FERNANDO CORDERO D.M.D.

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	1223G0001X	General Practice Dentistry	050874	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	:	1558402123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FERNANDO CORDERO D.M.D.

Provider Business Mailing Address
First Line	:	6148 62ND AVE
Second Line	:	APARTMENT 2
City	:	MIDDLE VILLAGE
State	:	NY
Zip	:	11379-1009
Country	:	US
Telephone Number	:	718-417-7766
Fax Number	:	718-417-1305

Provider Business Practice Location Address
First Line	:	589 KNICKERBOCKER AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4742
Country	:	US
Telephone Number	:	718-366-9191
Fax Number	:	718-417-1305

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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