MEDICARE: ELIAS HERNANDEZ PEREZ FNP-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	363LF0000X	Family Nurse Practitioner	353926	NY

General Provider Information

NPI Number	:	1922681527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIAS HERNANDEZ PEREZ FNP-C

Provider Business Mailing Address
First Line	:	828 E 149TH ST STE 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4670
Country	:	US
Telephone Number	:	347-431-0154
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 E 149TH ST STE 2
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4670
Country	:	US
Telephone Number	:	347-431-0154
Fax Number	:

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

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	10/11/2025

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