Basic Information
Provider Information | |||||||||
NPI: | 1508974676 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HERTZBERG | ||||||||
FirstName: | HERMAN | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | AUD, CNIM | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1086 TEANECK RD | ||||||||
Address2: | SUITE 4A | ||||||||
City: | TEANECK | ||||||||
State: | NJ | ||||||||
PostalCode: | 076664854 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2018629900 | ||||||||
FaxNumber: | 2018629136 | ||||||||
Practice Location | |||||||||
Address1: | 1086 TEANECK RD | ||||||||
Address2: | SUITE 4A | ||||||||
City: | TEANECK | ||||||||
State: | NJ | ||||||||
PostalCode: | 076664854 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2018629900 | ||||||||
FaxNumber: | 2018629136 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/28/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | X |   | Other Service Providers | Specialist |   | 231H00000X | 000270-1 | NY | X |   | Speech, Language and Hearing Service Providers | Audiologist |   |
No ID Information.