Healthcare Provider Details

I. General information

NPI: 1023366861
Provider Name (Legal Business Name): MARCO T HERNANDEZ PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 E 163RD ST BRONX
BRONX NY
10459-4309
US

IV. Provider business mailing address

1024 E 163RD ST BRONX
BRONX NY
10459-4309
US

V. Phone/Fax

Practice location:
  • Phone: 718-542-6800
  • Fax: 718-842-3641
Mailing address:
  • Phone: 718-542-6800
  • Fax: 718-842-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number115852
License Number StateNY

VIII. Authorized Official

Name: DR. SEAN JOSEPH
Title or Position: OFFICE-BILLING MANAGER
Credential:
Phone: 212-491-9410