Provider Demographics
NPI:1154471993
Name:HERTAN, HILARY (MD)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:
Last Name:HERTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 EAST 233RD ST.
Mailing Address - Street 2:OLMMC, DEPT. OF GI
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:718-920-9692
Mailing Address - Fax:718-920-6857
Practice Address - Street 1:600 EAST 233RD ST.
Practice Address - Street 2:OLMMC, DEPT. OF GI
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-920-9692
Practice Address - Fax:718-920-6857
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156652207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01180230Medicaid
NYE76303Medicare UPIN
NY01180230Medicaid