Provider Demographics
NPI:1427152750
Name:HERNANDEZ, RENEE (MD)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name: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 1:893B PROSPECT AVE
Mailing Address - Street 2:1712
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459
Mailing Address - Country:US
Mailing Address - Phone:718-620-2244
Mailing Address - Fax:718-620-2386
Practice Address - Street 1:888 EAST 163RD
Practice Address - Street 2:#3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459
Practice Address - Country:US
Practice Address - Phone:718-620-2244
Practice Address - Fax:718-620-2386
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02199526Medicaid
NY02199526Medicaid
NY028AG1Medicare ID - Type Unspecified