Provider Demographics
NPI:1679814925
Name:HERNANDEZ, ADALGISA (MED)
Entity Type:Individual
Prefix:MRS
First Name:ADALGISA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BELLEVUE PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1542
Mailing Address - Country:US
Mailing Address - Phone:646-842-3475
Mailing Address - Fax:
Practice Address - Street 1:65 BELLEVUE PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1542
Practice Address - Country:US
Practice Address - Phone:646-842-3475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169545252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency