NPIMap

Organization Active NPI

Bienvenido Fajardo, M.D.P.C.

  • Nephrology Physician
  • New York, NY
National Provider Identifier
1891937546
Registry record updated Aug 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
163674 Issued in NY
Legal business name
BIENVENIDO FAJARDO, M.D.P.C.
Practice address
37 Nagle Ave Apt 1D
New York, NY 10040
Phone
(212) 942-0808
Fax
(212) 942-1553
NPI assigned
Mar 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2018

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

Authorized official

Name
Dr. Bienvenido Fajardo, MDNPI 1528153467
Title
Medical Director
Phone
(212) 942-0808

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X 163674 NY Primary

Addresses

Primary practice location

37 Nagle Ave Apt 1D
New York, NY 10040

Mailing address

37 Nagle Ave Apt 1D
New York, NY 10040-1483
Phone (212) 942-0808

Other identifiers 1

IdentifierTypeStateIssuer
01016260MedicaidNY

Other names 1

  • Associated Medical Group, PC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090409000129 NY Part B Supplier - Clinic/Group Practice 1658428685 Receives reassigned benefits from 6 practitioners
Practice locations: New York, NY

National Provider Directory

National Provider Directory

Locations

140 Wadsworth Ave
Apt 4
New York, NY 10033
Phone (212) 543-9700

2 Sickles St
#12
New York, NY 10040
Phone (212) 942-0808

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534982400000",
    "number": "1891937546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 NAGLE AVE APT 1D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100401483",
            "telephone_number": "212-942-0808",
            "fax_number": "212-942-1553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 NAGLE AVE APT 1D",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10040",
            "telephone_number": "212-942-0808",
            "fax_number": "212-942-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIENVENIDO FAJARDO, M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-27",
        "last_updated": "2018-08-23",
        "status": "A",
        "authorized_official_last_name": "FAJARDO",
        "authorized_official_first_name": "BIENVENIDO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "212-942-0808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "NY",
            "license": "163674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01016260",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Associated Medical Group, PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Associated Medical Group, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.