Provider Demographics
NPI:1073867339
Name:HERSCHITZ, SIMONA ELLEN (MA)
Entity Type:Individual
Prefix:MS
First Name:SIMONA
Middle Name:ELLEN
Last Name:HERSCHITZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NEPTUNE AVE APT 17P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4324
Mailing Address - Country:US
Mailing Address - Phone:718-781-9921
Mailing Address - Fax:
Practice Address - Street 1:460 NEPTUNE AVE APT 17P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4324
Practice Address - Country:US
Practice Address - Phone:718-781-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist