Provider Demographics
NPI:1356488282
Name:HERMAN, BRUCE S (PHD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:S
Last Name:HERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE N214
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-358-9000
Mailing Address - Fax:516-358-9802
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE N214
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-358-9000
Practice Address - Fax:516-358-9802
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5348103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV880LMedicare ID - Type Unspecified