Provider Demographics
NPI:1235544800
Name:HERRICK, HEDY ELDIWANY (LAC, DIPL OM)
Entity Type:Individual
Prefix:MRS
First Name:HEDY
Middle Name:ELDIWANY
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3706
Mailing Address - Country:US
Mailing Address - Phone:315-559-7197
Mailing Address - Fax:
Practice Address - Street 1:119 W 23RD ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-2427
Practice Address - Country:US
Practice Address - Phone:646-389-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005337-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist