MEDICARE: DR. HENRY FERNANDEZ-COS

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	11737	OTHER	NJ	UHP #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	55D651	OTHER	NJ	EMPIRE BC/BS # WNY
4	55D653	OTHER	NJ	EMPIRE BC/BS # ENGLEWOOD
5	J38367	OTHER	NJ	HEALTHNET #
6	044262	OTHER	NJ	HIP PROVIDER #
7	0650430001	OTHER	NJ	AMERIHEALTH #
8	4207231	OTHER	NJ	AETNA PPO #
9	9537733	OTHER	NJ	GHI PPO #
10	2223587	OTHER	NJ	AETNA HMO #
11	P771423	OTHER	NJ	OXFORD PROVIDER #

General Provider Information

NPI Number	:	1881698157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRY FERNANDEZ-COS

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	:	201-861-9272

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	:	201-861-9272

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/11/2008

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