Provider Demographics
NPI:1760813893
Name:HERNANDEZ, STALIN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STALIN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 196TH ST
Mailing Address - Street 2:APT 8
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-3608
Mailing Address - Country:US
Mailing Address - Phone:347-737-8965
Mailing Address - Fax:
Practice Address - Street 1:116 W 32ND ST
Practice Address - Street 2:8TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:212-564-2350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454937-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse