Provider Demographics
NPI:1295772812
Name:HERNANDEZ, MILAGROS (MD)
Entity type:Individual
Prefix:
First Name:MILAGROS
Middle Name:
Last Name:HERNANDEZ
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 1:3010 38TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3804
Mailing Address - Country:US
Mailing Address - Phone:718-545-2424
Mailing Address - Fax:718-932-9131
Practice Address - Street 1:3010 38TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3804
Practice Address - Country:US
Practice Address - Phone:718-545-2424
Practice Address - Fax:718-932-9131
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194459207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01680299Medicaid
NYG22715Medicare UPIN
NY01680299Medicaid