Provider Demographics
NPI:1619030426
Name:HERNANDEZ, MARTA C (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:C
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WINTERBERRY CT
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-4153
Mailing Address - Country:US
Mailing Address - Phone:917-640-4389
Mailing Address - Fax:
Practice Address - Street 1:13 WINTERBERRY CT
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-4153
Practice Address - Country:US
Practice Address - Phone:917-640-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01725819Medicaid
NY01725819Medicaid