Provider Demographics
NPI:1386179521
Name:HERNANDEZ GUZMAN, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HERNANDEZ GUZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:70 GLEN COVE RD STE 306
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1731
Mailing Address - Country:US
Mailing Address - Phone:516-621-7720
Mailing Address - Fax:516-625-4521
Practice Address - Street 1:70 GLEN COVE RD STE 306
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1731
Practice Address - Country:US
Practice Address - Phone:516-621-7720
Practice Address - Fax:166-254-5215
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303136207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine