Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 008307 | NY |
NPI | 1033358718 |
---|---|
Provider Name | Mr. Max Hernandez |
First Address | Jackson Heights, NY 11372 |
Second Address | Jackson Heights, NY 11372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 19/02/2009 |