Provider Demographics
NPI:1780775015
Name:HERNANDEZ, CAROLINE (DC)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:GONGORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 466
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778
Mailing Address - Country:US
Mailing Address - Phone:631-744-4688
Mailing Address - Fax:631-744-3220
Practice Address - Street 1:799 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778
Practice Address - Country:US
Practice Address - Phone:631-744-4688
Practice Address - Fax:631-744-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor