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General NPI Number Information
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NPI Number | 1518904036
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Entity Type | Individual
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Provider Name | VICTOR FABIO HERNANDEZ MD
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 301 60TH ST LOWER LEVEL
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5422
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Country | US
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Telephone | 201-295-3033
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Fax | 201-295-8592
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Provider Business Mailing Address
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Address Line | 301 60TH ST LOWER LEVEL
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5422
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Country | US
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Telephone | 201-295-3033
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Fax | 201-295-8592
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MA06477100
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License Number State | NJ
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