Provider Demographics
NPI:1922681527
Name:HERNANDEZ PEREZ, ELIAS (MSN,APRN,FNP,CORLN)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:
Last Name:HERNANDEZ PEREZ
Suffix:
Gender:M
Credentials:MSN,APRN,FNP,CORLN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SHAKESPEARE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3902
Mailing Address - Country:US
Mailing Address - Phone:929-263-6686
Mailing Address - Fax:
Practice Address - Street 1:1221 SHAKESPEARE AVE FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3902
Practice Address - Country:US
Practice Address - Phone:929-263-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY814814-01163WR0006X
NY353926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant