Provider Demographics
NPI:1164424958
Name:HERERA, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:HERERA
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 1:59 CHURCH ST.
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NJ
Mailing Address - Zip Code:07620
Mailing Address - Country:US
Mailing Address - Phone:201-784-6012
Mailing Address - Fax:201-784-4087
Practice Address - Street 1:106 GRAND AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3574
Practice Address - Country:US
Practice Address - Phone:201-503-1900
Practice Address - Fax:201-503-1901
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07569100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3005063OtherOXFORD#
NJ3349241OtherAETNA/USHC#
NJ0465J3OtherEMPIRE HC (NV) #
NJ2K7331OtherHEALTHNET#
NJ0465J2OtherEMPIRE HC (TE) #
NJ2836424000OtherAMERIHEALTH #
NJ0465J1OtherEMPIRE HC (HP) #
NJ7757464OtherAETNA#
NJP00040428OtherRAILROAD MDCR #
NJP3005063OtherOXFORD#
NJ7757464OtherAETNA#