Healthcare Provider Details

I. General information

NPI: 1902193196
Provider Name (Legal Business Name): KATRINA ELIO HERNANDEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2011
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 1ST AVE
NEW YORK NY
10016-6402
US

IV. Provider business mailing address

4705 CENTER BLVD APT 1012
LONG ISLAND CITY NY
11109-5740
US

V. Phone/Fax

Practice location:
  • Phone: 516-965-2449
  • Fax:
Mailing address:
  • Phone: 516-965-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116023153
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number275583
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number275583
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: