Provider Demographics
NPI:1568816403
Name:HERNANDEZ, RYAN (APN)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 CEDAR LN STE 201
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4312
Mailing Address - Country:US
Mailing Address - Phone:201-530-1900
Mailing Address - Fax:201-530-9300
Practice Address - Street 1:222 CEDAR LN STE 201
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4312
Practice Address - Country:US
Practice Address - Phone:201-530-1900
Practice Address - Fax:201-530-9300
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00632500363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care