Healthcare Provider Details

I. General information

NPI: 1871753004
Provider Name (Legal Business Name): HECTOR CHRISTIAN BERNABE RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 GRAND CONCOURSE
BRONX NY
10457-5201
US

IV. Provider business mailing address

764 10TH ST
SECAUCUS NJ
07094-2903
US

V. Phone/Fax

Practice location:
  • Phone: 718-716-1400
  • Fax:
Mailing address:
  • Phone: 201-522-8193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number024141
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: