1851381073 NPI number — DR. MILADYS A HERNANDEZ I D.D.S

Table of content: DR. MILADYS A HERNANDEZ I D.D.S (NPI 1851381073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851381073 NPI number — DR. MILADYS A HERNANDEZ I D.D.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
MILADYS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
I
Provider Credential Text:
D.D.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ
Provider Other First Name:
MILADYS
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
II
Provider Other Credential Text:
D.D.S
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1851381073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8723 112TH ST
Provider Second Line Business Mailing Address:
RICHMOND HILL
Provider Business Mailing Address City Name:
RICHMOND HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11418-2318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-846-8076
Provider Business Mailing Address Fax Number:
718-847-9464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 10 JAMAICA AVE
Provider Second Line Business Practice Location Address:
JAMAICA
Provider Business Practice Location Address City Name:
RICHMOND HILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11418-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-847-8807
Provider Business Practice Location Address Fax Number:
718-847-9464
Provider Enumeration Date:
10/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  044986 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01439427 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".