MEDICARE: ARIEL HERNANDEZ PTA

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	225200000X	Physical Therapy Assistant	40QB00369600	NJ

General Provider Information

NPI Number	:	1316564297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL HERNANDEZ PTA

Provider Business Mailing Address
First Line	:	265 FRANKLIN AVE
Second Line	:
City	:	NUTLEY
State	:	NJ
Zip	:	07110-2712
Country	:	US
Telephone Number	:	973-661-1207
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 NEW RD
Second Line	:
City	:	PARSIPPANY
State	:	NJ
Zip	:	07054-4273
Country	:	US
Telephone Number	:	973-396-8667
Fax Number	:

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	06/26/2020

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