Provider Demographics
NPI:1033488424
Name:JAY S. HERBST M.D., P.A.
Entity Type:Organization
Organization Name:JAY S. HERBST M.D., P.A.
Other - Org Name:SOUTH FLORIDA SKIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-764-1055
Mailing Address - Street 1:2866 TAMIAMI TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5126
Mailing Address - Country:US
Mailing Address - Phone:941-764-1055
Mailing Address - Fax:941-764-7984
Practice Address - Street 1:2866 TAMIAMI TRL
Practice Address - Street 2:SUITE A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5126
Practice Address - Country:US
Practice Address - Phone:941-764-1055
Practice Address - Fax:941-764-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 46734207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty