MEDICARE: DR. MYRNA HERNANDEZ M.D.

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	2084P0800X	Psychiatry Physician	184879-1	NY

General Provider Information

NPI Number	:	1831318179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYRNA HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	3651 HILL BLVD
Second Line	:
City	:	JEFFERSON VALLEY
State	:	NY
Zip	:	10535-1501
Country	:	US
Telephone Number	:	914-962-0688
Fax Number	:	914-243-5895

Provider Business Practice Location Address
First Line	:	3651 HILL BLVD
Second Line	:
City	:	JEFFERSON VALLEY
State	:	NY
Zip	:	10535-1501
Country	:	US
Telephone Number	:	914-962-0688
Fax Number	:	914-243-5895

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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