Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 231840 | NY |
NPI | 1164484523 |
---|---|
Provider Name | Angelica M Hernandez |
First Address | East Setauket, NY 11733-6401 |
Second Address | West Islip, NY 11795-4401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02588076 | (05) | NY |
I18067 | (02) | NY |