Provider Demographics
NPI:1285917823
Name:FERNANDEZ, ZARAH BAUTISTA (MD)
Entity type:Individual
Prefix:DR
First Name:ZARAH
Middle Name:BAUTISTA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:129 W 29TH ST FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5105
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:408 W 14TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-1042
Practice Address - Country:US
Practice Address - Phone:212-530-0639
Practice Address - Fax:212-867-4353
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFP3642Medicare PIN