=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245244185
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HERNAN JOSE ALAMILLA DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2006
-----------------------------------------------------
Last Update Date | 06/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13870 ELDER AVE 1J
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-539-2232
-----------------------------------------------------
Fax | 718-539-0488
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13870 ELDER AVE 1J
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-539-2232
-----------------------------------------------------
Fax | 718-539-0488
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 5261
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------