Individual provider Active NPI

Joanne Mercedes Fernandez-Booker, M.D., M.P.H.

  • Pediatrics Physician
  • Long Island City, NY
National Provider Identifier
1750768958
Registry record updated May 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
293308 Issued in NY
Practice address
4209 28TH St
Long Island City, NY 11101-4130
Phone
(212) 639-9675
NPI assigned
Apr 27, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Pediatrics Physician 208000000X 293308 NY Primary

Addresses

Primary practice location

4209 28TH St
Long Island City, NY 11101-4130

Mailing address

4209 28TH St
Long Island City, NY 11101-4130

Other practice location 1

100 Woods Rd
Valhalla, NY 10595-1530
Phone (914) 493-7000

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
293308NYMDPediatrics Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1750768958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4209 28TH ST",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111014130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4209 28TH ST",
            "city": "LONG ISLAND CITY",
            "state": "NY",
            "postal_code": "111014130",
            "telephone_number": "212-639-9675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Woods Rd",
            "address_purpose": "LOCATION",
            "city": "Valhalla",
            "state": "NY",
            "postal_code": "105951530",
            "country_code": "US",
            "telephone_number": "914-493-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ-BOOKER",
        "first_name": "JOANNE",
        "middle_name": "MERCEDES",
        "name_prefix": "Dr.",
        "credential": "M.D., M.P.H.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-27",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "293308",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Island City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.