Provider Demographics
NPI:1659187979
Name:HERNANDEZ, DAVID (NREMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CLINTON RD UNIT 1271
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07007-7038
Mailing Address - Country:US
Mailing Address - Phone:973-820-1711
Mailing Address - Fax:
Practice Address - Street 1:111 CENTRAL AVE # EMS
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-820-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1438-3160-4758146N00000X
NJ566558146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic