Basic Information
| Provider Information | |||||||||
| NPI: | 1922231265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERNANDO | ||||||||
| FirstName: | MARTY ANTONIO | ||||||||
| MiddleName: | BESERIL | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | DOCTORS ON CALL | ||||||||
| Address2: | 6010 BAY PARKWAY SUITE 901 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112046081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182382100 | ||||||||
| FaxNumber: | 7187480863 | ||||||||
| Practice Location | |||||||||
| Address1: | PARCARE COMMUNITY HEALTH NETWORK | ||||||||
| Address2: | 445 PARK AVENUE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112052735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189630800 | ||||||||
| FaxNumber: | 7185345221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2009 | ||||||||
| LastUpdateDate: | 02/18/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 031281 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.