Provider Demographics
NPI:1497217483
Name:HERNANDEZ, BRIAN JAMES
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:HERNANDEZ
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 1:46 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-6505
Mailing Address - Country:US
Mailing Address - Phone:516-242-0478
Mailing Address - Fax:
Practice Address - Street 1:1069 HEMPSTEAD TPKE # 1
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-2631
Practice Address - Country:US
Practice Address - Phone:516-865-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst