Provider Demographics
NPI:1023174596
Name:HERMOGENES, PATRICIA WONG (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:WONG
Last Name:HERMOGENES
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:13701 83RD AVE
Mailing Address - Street 2:1B
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1562
Mailing Address - Country:US
Mailing Address - Phone:718-847-3501
Mailing Address - Fax:718-847-4706
Practice Address - Street 1:13701 83RD AVE
Practice Address - Street 2:1B
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-1562
Practice Address - Country:US
Practice Address - Phone:718-847-3501
Practice Address - Fax:718-847-4706
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY188841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDP492OtherOXFORD HEALTH PLANS
NY188841OtherLICENSE
NY41K101OtherBLUE CROSS BLUE SHIELD
NY5900474OtherGHI
NYBH3201035OtherDEA NUMBER
NY41K101OtherBLUE CROSS BLUE SHIELD
NYBH3201035OtherDEA NUMBER