Provider Demographics
NPI:1073885984
Name:HERTZ, MICHAL (MA, RD)
Entity Type:Individual
Prefix:MRS
First Name:MICHAL
Middle Name:
Last Name:HERTZ
Suffix:
Gender:F
Credentials:MA, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WEST 79TH STREET
Mailing Address - Street 2:APT. 14F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:917-378-5554
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:212-510-7651
Practice Address - Fax:646-807-4812
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1070247133V00000X
NY01070247133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered