Provider Demographics
NPI:1073746558
Name:HERNANDEZ, HANNY MERCEDES (DPM)
Entity Type:Individual
Prefix:DR
First Name:HANNY
Middle Name:MERCEDES
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 ORLOFF AVE
Mailing Address - Street 2:APT 8C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2620
Mailing Address - Country:US
Mailing Address - Phone:917-403-6376
Mailing Address - Fax:
Practice Address - Street 1:625 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5049
Practice Address - Country:US
Practice Address - Phone:718-933-1900
Practice Address - Fax:718-563-4039
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY65006334213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03247192Medicaid
NY03247192Medicaid