Healthcare Provider Details

I. General information

NPI: 1003370875
Provider Name (Legal Business Name): KIMBERLY HERNANDEZ OQUENDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY HERNANDEZ MD

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7919 KENNEDY BLVD
NORTH BERGEN NJ
07047-4137
US

IV. Provider business mailing address

7919 KENNEDY BLVD
NORTH BERGEN NJ
07047-4137
US

V. Phone/Fax

Practice location:
  • Phone: 201-528-3664
  • Fax: 201-528-3662
Mailing address:
  • Phone: 201-528-3664
  • Fax: 201-528-3662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA13206700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: