1871591198 NPI number — DR. JON DAVID HERNANDEZ M.D.

Table of content: DR. JON DAVID HERNANDEZ M.D. (NPI 1871591198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871591198 NPI number — DR. JON DAVID HERNANDEZ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
JON
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871591198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 MACK BLVD FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103-5622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-884-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2226 BLAKESLEE BOULEVARD DR E STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-9619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-408-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2005

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: 207X00000X , with the licence number:  MD424128 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: MD424128 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1010825780001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2170525 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2454072 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90334 . This is a "GEISINGER HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00144458 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3253696 . This is a "OXFORD HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1614028 . This is a "HIGHMARK BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0651358 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2291153000 . This is a "INDEPENDENCE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2291153000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 328962 . This is a "HEALTH AMERICA/HEALTH ASS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50044348 . This is a "CAPITAL BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50044348 . This is a "KEYSTONE HEALTH CENTRAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 819317 . This is a "FIRST PRIORITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9336898 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2291153000 . This is a "KEYSTONE HEALTH EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 556421 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com