Provider Demographics
NPI:1083884084
Name:AMY B HERSKOWITZ
Entity Type:Organization
Organization Name:AMY B HERSKOWITZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:609-617-4337
Mailing Address - Street 1:2301 E EVESHAM RD STE 302
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4503
Mailing Address - Country:US
Mailing Address - Phone:856-770-1313
Mailing Address - Fax:856-770-1297
Practice Address - Street 1:2301 E EVESHAM RD STE 302
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4503
Practice Address - Country:US
Practice Address - Phone:856-770-1313
Practice Address - Fax:856-770-1297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00208400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ022104Medicare PIN
NJ0301320001Medicare NSC