Provider Demographics
NPI:1376631754
Name:DAVIDOVICZ, HERMAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:M
Last Name:DAVIDOVICZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 N STATION PLZ
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5011
Mailing Address - Country:US
Mailing Address - Phone:516-487-4466
Mailing Address - Fax:516-487-4485
Practice Address - Street 1:45 N STATION PLZ
Practice Address - Street 2:SUITE 305
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5011
Practice Address - Country:US
Practice Address - Phone:516-487-4466
Practice Address - Fax:516-487-4485
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004955-1103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist