Provider Demographics
NPI:1700581949
Name:HERNANDEZ, DANIEL JONAH (ATS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JONAH
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CONSTANT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-2902
Mailing Address - Country:US
Mailing Address - Phone:718-737-6177
Mailing Address - Fax:
Practice Address - Street 1:56 CONSTANT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2902
Practice Address - Country:US
Practice Address - Phone:718-737-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer