Basic Information
Provider Information | |||||||||
NPI: | 1154645844 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HERNANDEZ | ||||||||
FirstName: | ESPERANZA | ||||||||
MiddleName: | H | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | STEINBERG | ||||||||
OtherFirstName: | ESPERANZA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PHD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 4301 PARK AVE | ||||||||
Address2: | 9E | ||||||||
City: | UNION CITY | ||||||||
State: | NJ | ||||||||
PostalCode: | 070876579 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2017237402 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 910 W END AVE | ||||||||
Address2: | 1C | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100253533 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2128518100 | ||||||||
FaxNumber: | 2129320964 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/24/2010 | ||||||||
LastUpdateDate: | 07/30/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/30/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 018524 | NY | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 003421 | CT | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
ID | Type | State | Issuer | Description | 03205098 | 05 | NY |   | MEDICAID |