Provider Demographics
NPI:1245360833
Name:JESUS M. HERNANDEZ, M.D., P.C.
Entity type:Organization
Organization Name:JESUS M. HERNANDEZ, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-740-2270
Mailing Address - Street 1:271 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE AA
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1218
Mailing Address - Country:US
Mailing Address - Phone:212-740-2270
Mailing Address - Fax:212-923-0908
Practice Address - Street 1:271 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE AA
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1218
Practice Address - Country:US
Practice Address - Phone:212-740-2270
Practice Address - Fax:212-923-0908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163969208100000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00922752Medicaid
NY00922752Medicaid
NY00922752Medicaid
NY57D781Medicare ID - Type UnspecifiedMEDICARE ID#