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General NPI Number Information
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NPI Number | 1205343001
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Entity Type | Individual
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Provider Name | REBECCA M HERMOS
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Gender | Female
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 03/25/2019
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Provider Practice Location Address
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Address Line | 50 COURT ST
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City | BROOKLYN
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State | NY
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Zip | 11201-4879
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Country | US
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Telephone | 718-630-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 45 PLAZA ST W
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City | BROOKLYN
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State | NY
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Zip | 11217-3952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 019831
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License Number State | NY
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