Provider Demographics
NPI:1699870170
Name:FERNANDO PUJOL MD PC
Entity type:Organization
Organization Name:FERNANDO PUJOL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PUJOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-636-7400
Mailing Address - Street 1:460 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5207
Mailing Address - Country:US
Mailing Address - Phone:718-636-7400
Mailing Address - Fax:718-636-7432
Practice Address - Street 1:460 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5207
Practice Address - Country:US
Practice Address - Phone:718-636-7400
Practice Address - Fax:718-636-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163062207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01044173Medicaid
NYB95533Medicare UPIN
NY89D081Medicare PIN