Provider Demographics
NPI:1083750913
Name:HERNANDEZ, JESUS M (MD)
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE AA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1218
Mailing Address - Country:US
Mailing Address - Phone:212-740-2270
Mailing Address - Fax:212-923-0908
Practice Address - Street 1:271 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE AA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1218
Practice Address - Country:US
Practice Address - Phone:212-740-2270
Practice Address - Fax:212-923-0908
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163969208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00922752Medicaid
NY00922752Medicaid
NY00922752Medicaid
NYA63338Medicare UPIN