Provider Demographics
NPI:1578669693
Name:HERNANDEZ, WILLIAM ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTHONY
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:85 W MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8345
Mailing Address - Country:US
Mailing Address - Phone:631-968-6300
Mailing Address - Fax:631-968-5886
Practice Address - Street 1:85 W MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8345
Practice Address - Country:US
Practice Address - Phone:631-968-6300
Practice Address - Fax:631-968-5886
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3933213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01098342Medicaid
NY480032633OtherRAILROAD MEDICARE
NYP44321Medicare PIN
NYT51394Medicare UPIN