Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0534721 | NY |
NPI | 1104039981 |
---|---|
Provider Name | Dr. Susan Hernandez |
First Address | Brooklyn, NY 11209-2702 |
Second Address | Brooklyn, NY 11209-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 26/12/2012 |