Healthcare Provider Details

I. General information

NPI: 1720348105
Provider Name (Legal Business Name): ANGIE LORENA HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2012
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 RICHMOND AVE STE 1L
STATEN ISLAND NY
10314-3961
US

IV. Provider business mailing address

2066 RICHMOND AVE STE 1L
STATEN ISLAND NY
10314-3961
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-9001
  • Fax: 718-982-9008
Mailing address:
  • Phone: 718-982-9001
  • Fax: 718-982-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number272686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: