Provider Demographics
NPI:1326191248
Name:HERTZ, HOWARD L (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:L
Last Name:HERTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1199 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-2552
Mailing Address - Country:US
Mailing Address - Phone:732-549-5820
Mailing Address - Fax:732-536-3859
Practice Address - Street 1:1199 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-2552
Practice Address - Country:US
Practice Address - Phone:732-549-5820
Practice Address - Fax:732-536-3859
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00376300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0447609Medicaid
NJU25565Medicare UPIN
NJ0447609Medicaid