Provider Demographics
NPI:1316944051
Name:FERNANDEZ-OBREGON, ADOLFO CARLOS (MD)
Entity type:Individual
Prefix:DR
First Name:ADOLFO
Middle Name:CARLOS
Last Name:FERNANDEZ-OBREGON
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 1:10 CHURCH TWRS
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2757
Mailing Address - Country:US
Mailing Address - Phone:201-795-3376
Mailing Address - Fax:201-795-5515
Practice Address - Street 1:10 CHURCH TWRS
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2757
Practice Address - Country:US
Practice Address - Phone:201-795-3376
Practice Address - Fax:201-795-5515
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-09-18
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NJMA049726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ441227Medicare ID - Type Unspecified
NJB03647Medicare UPIN