Provider Demographics
NPI:1376704221
Name:HERSCHTHAL, JORDANA MANNY (MD)
Entity Type:Individual
Prefix:DR
First Name:JORDANA
Middle Name:MANNY
Last Name:HERSCHTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 NW 12TH AVE
Mailing Address - Street 2:2ND FLOOR MOHS UNIT
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1002
Mailing Address - Country:US
Mailing Address - Phone:305-243-6704
Mailing Address - Fax:
Practice Address - Street 1:7280 W PALMETTO PARK RD STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3412
Practice Address - Country:US
Practice Address - Phone:561-391-9200
Practice Address - Fax:561-338-7027
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111839207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program