Basic Information
| Provider Information | |||||||||
| NPI: | 1740734524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MANUEL FERNANDEZ MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1070 HIGHWAY 34 | ||||||||
| Address2: | |||||||||
| City: | MATAWAN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077473469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089029982 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 MAY ST | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088373267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326619075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2016 | ||||||||
| LastUpdateDate: | 08/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | FERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7328264177 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 305R00000X | 03550900 | NJ | Y | Managed Care Organizations | Preferred Provider Organization |
No ID Information.