Provider Demographics
NPI:1164484523
Name:HERNANDEZ, ANGELICA M (MD)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:45 RESEARCH WAY
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6401
Mailing Address - Country:US
Mailing Address - Phone:631-615-8279
Mailing Address - Fax:631-350-7200
Practice Address - Street 1:320 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4401
Practice Address - Country:US
Practice Address - Phone:631-587-2500
Practice Address - Fax:631-587-0292
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2021-10-14
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Provider Licenses
StateLicense IDTaxonomies
NY231840207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02588076Medicaid
NY02588076Medicaid
NYI18067Medicare UPIN