Provider Demographics
NPI:1932137106
Name:HERNANDEZ, LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINCOLN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 FORT WASHINGTON AVE STE PE1C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4626
Mailing Address - Country:US
Mailing Address - Phone:212-795-1021
Mailing Address - Fax:212-795-1002
Practice Address - Street 1:495 FORT WASHINGTON AVE STE PE1C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4626
Practice Address - Country:US
Practice Address - Phone:212-795-1021
Practice Address - Fax:212-795-1002
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237063207R00000X
LAMD.201644207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA4006448OtherMEDICARE
NY02768849Medicaid
MS06424064Medicaid