Healthcare Provider Details

I. General information

NPI: 1992236285
Provider Name (Legal Business Name): JASON E HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 06/14/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD STE 106
HACKENSACK NJ
07601-1749
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD BLDG 2 , SUITE 220
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 201-441-9980
  • Fax:
Mailing address:
  • Phone: 732-807-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301504718
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA10840300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: