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General NPI Number Information
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NPI Number | 1194703199
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Entity Type | Organization
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Legal Business Name | IVAN HERNANDEZ MD PC
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 01/12/2011
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Provider Practice Location Address
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Address Line | 1367 UNION ST
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City | SCHENECTADY
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State | NY
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Zip | 12308-3019
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Country | US
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Telephone | 518-382-9585
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Fax | 518-382-9685
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Provider Business Mailing Address
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Address Line | 1367 UNION STREET
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City | SCHENECTADY
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State | NY
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Zip | 12308-4019
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Country | US
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Telephone | 518-382-9585
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Fax | 518-382-9685
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IVAN AURELIO HERNANDEZ
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Credential | MD FACS CWS FCCWS
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Telephone | 518-382-9585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 093218-1
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License Number State | NY
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