Provider Demographics
NPI:1225202526
Name:DANIEL J HERERA MD LLC
Entity Type:Organization
Organization Name:DANIEL J HERERA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-784-6012
Mailing Address - Street 1:59 CHURCH STREET
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:201-850-3190
Practice Address - Fax:201-503-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07569100208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty