Provider Demographics
NPI:1710703129
Name:FERNANDEZ, KRISTOFFER (MS)
Entity type:Individual
Prefix:MR
First Name:KRISTOFFER
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9802 62ND DR
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1741
Mailing Address - Country:US
Mailing Address - Phone:718-263-1587
Mailing Address - Fax:
Practice Address - Street 1:9802 62ND DR
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1741
Practice Address - Country:US
Practice Address - Phone:347-249-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist