Provider Demographics
NPI:1114596434
Name:HENNANDEZ, JOSE E
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:HENNANDEZ
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 1:85 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-1827
Mailing Address - Country:US
Mailing Address - Phone:862-297-5378
Mailing Address - Fax:
Practice Address - Street 1:85 N 17TH ST
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-1827
Practice Address - Country:US
Practice Address - Phone:862-297-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171WH0202XOther Service ProvidersContractorHome Modifications