Provider Demographics
NPI:1063498269
Name:SHERTZ, JOHN G JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:SHERTZ
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:SHERTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500 2345
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:717-263-5562
Mailing Address - Fax:717-263-1566
Practice Address - Street 1:2301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-3542
Practice Address - Country:US
Practice Address - Phone:215-952-9323
Practice Address - Fax:215-952-1496
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN268871L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014075630011Medicaid
PA077505Medicare PIN
PA0014075630011Medicaid
0775Q5Medicare ID - Type Unspecified