Healthcare Provider Details

I. General information

NPI: 1396296505
Provider Name (Legal Business Name): ANGELINA HERNANDEZ OSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

12 COPPERSMITH RD
LEVITTOWN NY
11756-4324
US

V. Phone/Fax

Practice location:
  • Phone: 516-756-2040
  • Fax: 516-576-2131
Mailing address:
  • Phone: 516-577-6402
  • Fax: 516-576-2131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number354307427
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier171M00000X
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerSERVICE PROVIDERS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: