MEDICARE: KILSY HERNANDEZ

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	174400000X	Specialist	2506883	NY

General Provider Information

NPI Number	:	1184037756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILSY HERNANDEZ

Provider Business Mailing Address
First Line	:	5800 ARLINGTON AVE
Second Line	:	APT 16F
City	:	BRONX
State	:	NY
Zip	:	10471-1402
Country	:	US
Telephone Number	:	917-731-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 ARLINGTON AVE
Second Line	:	APT 16F
City	:	BRONX
State	:	NY
Zip	:	10471-1402
Country	:	US
Telephone Number	:	917-731-5585
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2014
Last Update Date	:	06/11/2014

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Directions to “ KILSY HERNANDEZ ” Practice Location

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