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General NPI Number Information
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NPI Number | 1295881746
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Entity Type | Individual
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Provider Name | PETER ANTHONY HERNANDEZ DPM
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 85 W MAIN STREET SUITE 102
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City | BAY SHORE
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State | NY
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Zip | 11706
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Country | US
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Telephone | 631-968-6300
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Fax | 631-968-5886
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Provider Business Mailing Address
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Address Line | 85 W MAIN STREET SUITE 102
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City | BAY SHORE
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State | NY
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Zip | 11706
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Country | US
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Telephone | 631-968-6300
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Fax | 631-968-5886
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N0034761
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License Number State | NY
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