Provider Demographics
NPI:1215937453
Name:FERNANDEZ-GULMATICO, CHONA CUDAL (MD)
Entity type:Individual
Prefix:DR
First Name:CHONA
Middle Name:CUDAL
Last Name:FERNANDEZ-GULMATICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 EMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1709
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:3103 EMMONS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1709
Practice Address - Country:US
Practice Address - Phone:718-240-2000
Practice Address - Fax:718-240-2260
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188438-1208000000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01723880Medicaid
NYBG3229867OtherDEA NUMBER
NYF31416Medicare UPIN
NY01723880Medicaid