Provider Demographics
NPI:1659391274
Name:HERNANDEZ, ALLYN (MD)
Entity Type:Individual
Prefix:
First Name:ALLYN
Middle Name:
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 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-206-2230
Mailing Address - Fax:908-206-2237
Practice Address - Street 1:1 ROBERTSON DR
Practice Address - Street 2:SUITE 16
Practice Address - City:BEDMINSTER
Practice Address - State:NJ
Practice Address - Zip Code:07921-1716
Practice Address - Country:US
Practice Address - Phone:908-234-0205
Practice Address - Fax:908-470-3680
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA717532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9128506Medicaid
NJ051080Medicare Oscar/Certification
H50383Medicare UPIN