Provider Demographics
NPI:1609821909
Name:GORIS-HERNANDEZ, JOSELINA (APN)
Entity Type:Individual
Prefix:
First Name:JOSELINA
Middle Name:
Last Name:GORIS-HERNANDEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PROSPECT AVE
Mailing Address - Street 2:DIVISION OF GERIATRICS
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1914
Mailing Address - Country:US
Mailing Address - Phone:201-678-2994
Mailing Address - Fax:201-678-2976
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:DIVISION OF GERIATRICS
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-678-2994
Practice Address - Fax:201-678-2976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNR081726363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8101108Medicaid
026839DHKMedicare ID - Type Unspecified
NJ8101108Medicaid