MEDICARE: MIGUEL R. HERNANDEZ MD, P.C.

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	246969	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912286469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGUEL R. HERNANDEZ MD, P.C.

Provider Business Mailing Address
First Line	:	153 HOMEWOOD AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10701-5228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	286 FT WASHINGTON AVE SUITE 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3108
Country	:	US
Telephone Number	:	914-631-2600
Fax Number	:	914-631-0091

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MIGUEL RAFAEL HERNANDEZ
Credential	:	M.D
Telephone Number	:	718-323-5500

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	12/31/2014

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