Provider Demographics
NPI:1518904036
Name:HERNANDEZ, VICTOR FABIO (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:FABIO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:301 60TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5422
Mailing Address - Country:US
Mailing Address - Phone:201-295-3033
Mailing Address - Fax:201-295-8592
Practice Address - Street 1:301 60TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5422
Practice Address - Country:US
Practice Address - Phone:201-295-3033
Practice Address - Fax:201-295-8592
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA064771002084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7538308Medicaid
000520Medicare PIN
G57242Medicare UPIN