Provider Demographics
NPI:1568687176
Name:DR. JOHN G. HERNANDEZ & ASSOC. INC
Entity Type:Organization
Organization Name:DR. JOHN G. HERNANDEZ & ASSOC. INC
Other - Org Name:JOHN G. HERNANDEZ, MD ASSOC., INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER OF BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-745-0151
Mailing Address - Street 1:79 HIGHLAND AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2711
Mailing Address - Country:US
Mailing Address - Phone:978-745-0151
Mailing Address - Fax:978-745-0203
Practice Address - Street 1:79 HIGHLAND AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2711
Practice Address - Country:US
Practice Address - Phone:978-745-0151
Practice Address - Fax:978-745-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9753044Medicaid
MAB76371Medicare UPIN
MA9753044Medicaid