Provider Demographics
NPI:1558819565
Name:HERNANDEZ, YOEL JOSE
Entity type:Individual
Prefix:DR
First Name:YOEL
Middle Name:JOSE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18904 64TH AVE APT 6A
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3841
Mailing Address - Country:US
Mailing Address - Phone:347-779-7460
Mailing Address - Fax:
Practice Address - Street 1:18904 64TH AVE APT 6A
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3841
Practice Address - Country:US
Practice Address - Phone:347-779-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246ZC0007X246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant