Provider Demographics
NPI:1528498854
Name:HERNANDEZ, GLENYS (PA)
Entity type:Individual
Prefix:
First Name:GLENYS
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:190 S 8TH ST
Mailing Address - Street 2:APT 23
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-6143
Mailing Address - Country:US
Mailing Address - Phone:718-755-4962
Mailing Address - Fax:
Practice Address - Street 1:2103 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-1317
Practice Address - Country:US
Practice Address - Phone:631-574-2060
Practice Address - Fax:877-673-8535
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2018-03-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant