Provider Demographics
NPI:1245244185
Name:ALAMILLA, HERNAN JOSE (DPM)
Entity Type:Individual
Prefix:MR
First Name:HERNAN
Middle Name:JOSE
Last Name:ALAMILLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13870 ELDER AVE
Mailing Address - Street 2:1J
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-539-2232
Mailing Address - Fax:718-539-0488
Practice Address - Street 1:13870 ELDER AVE
Practice Address - Street 2:1J
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-539-2232
Practice Address - Fax:718-539-0488
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5261213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02362AMedicare ID - Type Unspecified
U64845Medicare UPIN
NY5071660001Medicare NSC