Healthcare Provider Details

I. General information

NPI: 1154690972
Provider Name (Legal Business Name): RICHARD PERALTA HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST STE C
SPRING VALLEY NY
10977-4917
US

IV. Provider business mailing address

25 S MAIN ST STE C
SPRING VALLEY NY
10977-4917
US

V. Phone/Fax

Practice location:
  • Phone: 845-694-3810
  • Fax: 845-694-3812
Mailing address:
  • Phone: 845-694-3810
  • Fax: 845-694-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number291697
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number291697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: