Healthcare Provider Details

I. General information

NPI: 1891721916
Provider Name (Legal Business Name): HERMINIA HERMOGENES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD BLDG. 56
WEST BRENTWOOD NY
11717-1043
US

IV. Provider business mailing address

7618 69TH PL
GLENDALE NY
11385-7134
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-2082
  • Fax: 631-761-2282
Mailing address:
  • Phone: 347-223-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number219212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: