MEDICARE: DR. VICTOR FABIO HERNANDEZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	25MA06477100	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518904036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR FABIO HERNANDEZ MD

Provider Business Mailing Address
First Line	:	301 60TH ST
Second Line	:	LOWER LEVEL
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5422
Country	:	US
Telephone Number	:	201-295-3033
Fax Number	:	201-295-8592

Provider Business Practice Location Address
First Line	:	301 60TH ST
Second Line	:	LOWER LEVEL
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5422
Country	:	US
Telephone Number	:	201-295-3033
Fax Number	:	201-295-8592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/19/2012

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