Provider Demographics
NPI:1659524270
Name:ALICIA W HERMOGENES MD PC
Entity Type:Organization
Organization Name:ALICIA W HERMOGENES MD PC
Other - Org Name:ALICIA W HERMOGENES MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:HERMOGENES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-894-5071
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-0173
Mailing Address - Country:US
Mailing Address - Phone:716-894-5071
Mailing Address - Fax:716-894-5072
Practice Address - Street 1:2925 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-3103
Practice Address - Country:US
Practice Address - Phone:716-894-5071
Practice Address - Fax:716-894-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY195934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000201Medicare PIN