Provider Demographics
NPI:1871937896
Name:HERNANDEZ, IRIS
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WARBURTON AVE
Mailing Address - Street 2:3M
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1052
Mailing Address - Country:US
Mailing Address - Phone:646-283-5268
Mailing Address - Fax:
Practice Address - Street 1:1100 WARBURTON AVE
Practice Address - Street 2:3M
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1052
Practice Address - Country:US
Practice Address - Phone:646-283-5268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY851186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist