Healthcare Provider Details

I. General information

NPI: 1063345825
Provider Name (Legal Business Name): JAHAIRA HERNANDEZ NYCPS-P-919400
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BROADWAY
NEWBURGH NY
12550-6204
US

IV. Provider business mailing address

30 INDUSTRIAL DR
MIDDLETOWN NY
10941-1662
US

V. Phone/Fax

Practice location:
  • Phone: 845-862-6160
  • Fax: 845-378-3284
Mailing address:
  • Phone: 845-342-1162
  • Fax: 845-843-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberNYCPS-P-919400
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: