Provider Demographics
NPI:1245410521
Name:BERNARD HERSHENBERG PHD PA
Entity Type:Organization
Organization Name:BERNARD HERSHENBERG PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSHENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-424-7272
Mailing Address - Street 1:1874 ROUTE 70 E
Mailing Address - Street 2:SUITE4
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2037
Mailing Address - Country:US
Mailing Address - Phone:856-424-7272
Mailing Address - Fax:856-424-6977
Practice Address - Street 1:1874 ROUTE 70 E
Practice Address - Street 2:SUITE4
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2037
Practice Address - Country:US
Practice Address - Phone:856-424-7272
Practice Address - Fax:856-424-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJSI01116103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ140671Medicare PIN