Healthcare Provider Details

I. General information

NPI: 1508647694
Provider Name (Legal Business Name): VICTOR HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E PUTNAM AVE STE 2
OLD GREENWICH CT
06870-1360
US

IV. Provider business mailing address

392 IRVING AVE
PORT CHESTER NY
10573-3052
US

V. Phone/Fax

Practice location:
  • Phone: 203-817-0196
  • Fax:
Mailing address:
  • Phone: 914-565-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051842
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: