Provider Demographics
NPI:1184651952
Name:FERNAND, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:FERNAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 HAMBURG TPKE
Mailing Address - Street 2:SUITE # 12
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2062
Mailing Address - Country:US
Mailing Address - Phone:973-595-7922
Mailing Address - Fax:973-595-7052
Practice Address - Street 1:516 HAMBURG TPKE
Practice Address - Street 2:SUITE # 12
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2062
Practice Address - Country:US
Practice Address - Phone:973-595-7922
Practice Address - Fax:973-595-7052
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23964207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
503097Medicare PIN
NJC56520Medicare UPIN