Provider Demographics
NPI:1538663471
Name:HERNANDEZ, OLGA GISELLE
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:GISELLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-2124
Mailing Address - Country:US
Mailing Address - Phone:845-360-6658
Mailing Address - Fax:485-291-2418
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-2124
Practice Address - Country:US
Practice Address - Phone:845-360-6658
Practice Address - Fax:485-291-2418
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator