Provider Demographics
NPI:1144369158
Name:HERMANO, LOURDES (MD)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:HERMANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15038 UNION TPKE
Mailing Address - Street 2:APT. 8S
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3948
Mailing Address - Country:US
Mailing Address - Phone:718-380-0136
Mailing Address - Fax:
Practice Address - Street 1:15038 UNION TPKE
Practice Address - Street 2:APT. 8S
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3948
Practice Address - Country:US
Practice Address - Phone:718-380-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY113878283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital