Provider Demographics
NPI:1194059899
Name:MENA HERNANDEZ, HERBERT MAURICIO (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MAURICIO
Last Name:MENA HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1466
Mailing Address - Country:US
Mailing Address - Phone:516-270-7819
Mailing Address - Fax:
Practice Address - Street 1:2100 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1445
Practice Address - Country:US
Practice Address - Phone:718-892-1626
Practice Address - Fax:718-892-7060
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine