Healthcare Provider Details

I. General information

NPI: 1689807570
Provider Name (Legal Business Name): EDUARDO HERMIDA BARRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST DEPARTMENT OF ANESTHESIOLOGY
BRONX NY
10467-2401
US

IV. Provider business mailing address

33 SHORT HILLS CIR APT 3A
MILLBURN NJ
07041-1240
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-2802
  • Fax:
Mailing address:
  • Phone: 646-704-4256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number003434
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number003434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: