Basic Information
| Provider Information | |||||||||
| NPI: | 1285071043 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | KATE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES | ||||||||
| OtherFirstName: | ALYSSA | ||||||||
| OtherMiddleName: | KATE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 416457 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022416457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443621735 | ||||||||
| FaxNumber: | 9732907495 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 E 2ND ST | ||||||||
| Address2: | |||||||||
| City: | SCOTCH PLAINS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070761749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9083227786 | ||||||||
| FaxNumber: | 9083220191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 05/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT204767 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | MT204767 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 25MA10066300 | NJ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.