Provider Demographics
NPI:1255305538
Name:HERMAN, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HERMAN
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 1:2500 MARCUS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE SUCCESS
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1018
Mailing Address - Country:US
Mailing Address - Phone:516-358-1200
Mailing Address - Fax:516-358-2340
Practice Address - Street 1:2500 MARCUS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE SUCCESS
Practice Address - State:NY
Practice Address - Zip Code:11042-1018
Practice Address - Country:US
Practice Address - Phone:516-358-1200
Practice Address - Fax:516-358-2340
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188818207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF63467Medicare UPIN
NYJH008J2820Medicare ID - Type Unspecified