MEDICARE: HECTOR CHRISTIAN BERNABE RDH

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	124Q00000X	Dental Hygienist	024141	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	024141	OTHER	NY	DENTAL HYGIENE LICENSE

General Provider Information

NPI Number	:	1871753004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR CHRISTIAN BERNABE RDH

Provider Business Mailing Address
First Line	:	764 10TH ST
Second Line	:
City	:	SECAUCUS
State	:	NJ
Zip	:	07094-2903
Country	:	US
Telephone Number	:	201-522-8193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-5201
Country	:	US
Telephone Number	:	718-716-1400
Fax Number	:

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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