Healthcare Provider Details

I. General information

NPI: 1164783254
Provider Name (Legal Business Name): XEQUIEL HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 BROADWAY
NEW YORK NY
10034-1609
US

IV. Provider business mailing address

5030 BROADWAY
NEW YORK NY
10034-1609
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-6550
  • Fax:
Mailing address:
  • Phone: 212-604-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number313169
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number313169
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: