Basic Information
| Provider Information | |||||||||
| NPI: | 1740280957 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERSHAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 N BEDFORD RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MOUNT KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105492553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146668866 | ||||||||
| FaxNumber: | 9146666777 | ||||||||
| Practice Location | |||||||||
| Address1: | 7600 RIVER RD | ||||||||
| Address2: | PALISADES MEDICAL CENTER | ||||||||
| City: | NORTH BERGEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070476217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2018545172 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 53498 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 172940 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 6806309 | 05 | NJ | MEDICAID | 01424184 | 05 | NY | MEDICAID | 050042106 | 01 | NJ | RAIL ROAID MEDICARE | OTHER | 050088289 | 01 | NY | RAIL ROAD MEDICARE | OTHER |