Provider Demographics
NPI:1083758486
Name:HERKO, ELIZABETH JEAN (MPH, DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JEAN
Last Name:HERKO
Suffix:
Gender:F
Credentials:MPH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 CENTRAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1547
Mailing Address - Country:US
Mailing Address - Phone:908-376-9297
Mailing Address - Fax:908-673-0175
Practice Address - Street 1:571 CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1547
Practice Address - Country:US
Practice Address - Phone:908-698-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023388001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice