Provider Demographics
NPI:1962466813
Name:GINEBRA, FERNANDO ARTURO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ARTURO
Last Name:GINEBRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 SURREY RD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2036
Mailing Address - Country:US
Mailing Address - Phone:516-352-1819
Mailing Address - Fax:718-424-8487
Practice Address - Street 1:132 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4167
Practice Address - Country:US
Practice Address - Phone:718-484-8488
Practice Address - Fax:718-484-8487
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-16
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1971582080N0001X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01601770Medicaid