MEDICARE: SOMANGE FAJARDO

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1730023011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOMANGE FAJARDO

Provider Business Mailing Address
First Line	:	65 COOPER ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3066
Country	:	US
Telephone Number	:	347-764-9400
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 COOPER ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-3066
Country	:	US
Telephone Number	:	347-764-9400
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ SOMANGE FAJARDO ” Practice Location

Language	Start Address	Practice Location

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