Provider Demographics
NPI:1154688539
Name:EUGENE G. HERMAN, DMD, P.C.
Entity Type:Organization
Organization Name:EUGENE G. HERMAN, DMD, P.C.
Other - Org Name:EUGENE G. HERMAN, DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-766-3330
Mailing Address - Street 1:77 N CENTRE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3923
Mailing Address - Country:US
Mailing Address - Phone:516-766-3330
Mailing Address - Fax:516-766-3563
Practice Address - Street 1:77 N CENTRE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3923
Practice Address - Country:US
Practice Address - Phone:516-766-3330
Practice Address - Fax:516-766-3563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY130740146 NYOtherOTHER
NY00304765 NYMedicaid
NY00304765 NYMedicaid
NY130740146 NYOtherOTHER