MEDICARE: JEIMY D HERNANDEZ CRUZ

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1568318061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEIMY D HERNANDEZ CRUZ

Provider Business Mailing Address
First Line	:	287 SPRINGS FIREPLACE RD
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-4823
Country	:	US
Telephone Number	:	631-329-0373
Fax Number	:	718-210-3410

Provider Business Practice Location Address
First Line	:	287 SPRINGS FIREPLACE RD
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-4823
Country	:	US
Telephone Number	:	631-329-0373
Fax Number	:	718-210-3410

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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