Provider Demographics
NPI:1326345786
Name:STANLEY M HERTZ MD PC
Entity Type:Organization
Organization Name:STANLEY M HERTZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-484-6366
Mailing Address - Street 1:55 FERN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2201
Mailing Address - Country:US
Mailing Address - Phone:516-484-6366
Mailing Address - Fax:516-484-2864
Practice Address - Street 1:55 FERN DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2201
Practice Address - Country:US
Practice Address - Phone:516-484-6366
Practice Address - Fax:516-484-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1274072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty