Provider Demographics
NPI:1275773723
Name:HERTIG, SAMUEL JAMES (PA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JAMES
Last Name:HERTIG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:426 CLOVERLEAF RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17022-9320
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-664-7659
Practice Address - Street 1:1250 S CEDAR CREST BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6224
Practice Address - Country:US
Practice Address - Phone:610-402-6555
Practice Address - Fax:610-402-6550
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA060879363AM0700X, 363A00000X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant