Provider Demographics
NPI:1457630865
Name:HERNANDEZ, ANGELA (CMT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 MARKET ST
Mailing Address - Street 2:2B
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5300
Mailing Address - Country:US
Mailing Address - Phone:201-712-0009
Mailing Address - Fax:
Practice Address - Street 1:383 MARKET ST
Practice Address - Street 2:2B
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5300
Practice Address - Country:US
Practice Address - Phone:201-712-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist