Active NPI
John Fernandes
- Pediatric Cardiology Physician
- New York, NY
National Provider Identifier
1073589883
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Cardiology Physician
- License
- 175252
- Practice address
- 3959 Broadway
Columbia University Departmt .Pediatric
New York, NY 10032-1559 - Phone
- (212) 304-7250
- Fax
- (212) 544-1974
- NPI assigned
- Feb 23, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Cardiology Physician | 2080P0202X | 175252 | NY | Primary |
Addresses
Primary practice location
3959 Broadway
Columbia University Departmt .Pediatric
New York, NY 10032-1559
Mailing address
9 Koewing PL
West Orange, NY 10032
Phone (212) 304-7250
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01851101 | Medicaid | NY | |
| 002673 | Other | NJ | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 175252 | NY | MD | Pediatric Cardiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268179200000",
"number": "1073589883",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 KOEWING PL",
"city": "WEST ORANGE",
"state": "NY",
"postal_code": "10032",
"telephone_number": "212-304-7250",
"fax_number": "212-544-1974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3959 BROADWAY",
"address_2": "COLUMBIA UNIVERSITY DEPARTMT .PEDIATRIC",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100321559",
"telephone_number": "212-304-7250",
"fax_number": "212-544-1974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERNANDES",
"first_name": "JOHN",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-23",
"last_updated": "2010-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0202X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Cardiology",
"state": "NY",
"license": "175252",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01851101",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "002673",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.