Provider Demographics
NPI:1306867494
Name:HERMAN, AMIR (DO)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:HERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 LARKFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4205
Mailing Address - Country:US
Mailing Address - Phone:631-368-9166
Mailing Address - Fax:631-368-5682
Practice Address - Street 1:554 LARKFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4205
Practice Address - Country:US
Practice Address - Phone:631-368-9166
Practice Address - Fax:631-368-5682
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY226879207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI50298Medicare UPIN
NYA100026565Medicare PIN