Provider Demographics
NPI:1164782108
Name:HERTZ, JARED ADAM (DO)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:ADAM
Last Name:HERTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MALLARD DR
Mailing Address - Street 2:
Mailing Address - City:LLOYD HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11743-9712
Mailing Address - Country:US
Mailing Address - Phone:646-246-7377
Mailing Address - Fax:
Practice Address - Street 1:350 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3417
Practice Address - Country:US
Practice Address - Phone:631-661-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11772207R00000X
NY263785207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine