Provider Demographics
NPI:1760829592
Name:HERNANDEZ, ERNESTO (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4135 67TH ST UNIT MD1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3718
Mailing Address - Country:US
Mailing Address - Phone:347-808-9400
Mailing Address - Fax:347-354-5699
Practice Address - Street 1:4135 67TH ST UNIT MD1
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3718
Practice Address - Country:US
Practice Address - Phone:347-808-9400
Practice Address - Fax:888-977-2547
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103G00000X
NY022092103G00000X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty