Provider Demographics
NPI:1174748677
Name:HERNANDEZ PODIATRY P.C.
Entity type:Organization
Organization Name:HERNANDEZ PODIATRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:631-968-6300
Mailing Address - Street 1:85 W MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8345
Mailing Address - Country:US
Mailing Address - Phone:631-968-6300
Mailing Address - Fax:631-968-5886
Practice Address - Street 1:85 W MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8345
Practice Address - Country:US
Practice Address - Phone:631-968-6300
Practice Address - Fax:631-968-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCS816OtherOXFORD
NYCJ2956OtherRAILROAD MEDICARE
NY01098342Medicaid
NY11151OtherVYTRA
NYT51394Medicare UPIN
NY4364220001Medicare NSC
NYCJ2956OtherRAILROAD MEDICARE