MEDICARE: ARBOR MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	166698	NY

General Provider Information

NPI Number	:	1174650444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARBOR MEDICAL PC

Provider Business Mailing Address
First Line	:	6 PRESLEY ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3239
Country	:	US
Telephone Number	:	718-984-0969
Fax Number	:	718-984-4097

Provider Business Practice Location Address
First Line	:	6 PRESLEY ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3239
Country	:	US
Telephone Number	:	718-984-0969
Fax Number	:	718-984-4097

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. LISA ROSE HERNANDEZ
Credential	:	M.D.
Telephone Number	:	718-984-0969

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	12/20/2012

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Directions to “ARBOR MEDICAL PC ” Practice Location

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