Healthcare Provider Details

I. General information

NPI: 1295772812
Provider Name (Legal Business Name): MILAGROS HERNANDEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 38TH ST
ASTORIA NY
11103-3804
US

IV. Provider business mailing address

3010 38TH ST FL 2
ASTORIA NY
11103-3804
US

V. Phone/Fax

Practice location:
  • Phone: 718-545-2424
  • Fax: 718-932-9131
Mailing address:
  • Phone: 718-545-2424
  • Fax: 718-932-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number194459
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: