Provider Demographics
NPI:1891721916
Name:HERMOGENES, HERMINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMINIA
Middle Name:
Last Name:HERMOGENES
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 1:7618 69TH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7134
Mailing Address - Country:US
Mailing Address - Phone:347-223-4270
Mailing Address - Fax:
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:BLDG. 56
Practice Address - City:WEST BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1043
Practice Address - Country:US
Practice Address - Phone:631-761-2082
Practice Address - Fax:631-761-2282
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2192122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH77664Medicare UPIN